Which Men Do or Do Not Achieve Long-Term Symptom Relief After Holmium Laser Enucleation of the Prostate (HoLEP): 11 Years of HoLEP Experience

Autor: Philipp Gild, Malte W. Vetterlein, Ihab Daoud, Tim A. Ludwig, Armin Soave, Phillip Marks, Felix K.-H. Chun, Sascha Ahyai, Roland Dahlem, Margit Fisch, Michael Rink, Christian P. Meyer, Andreas Becker
Rok vydání: 2023
Předmět:
Zdroj: Journal of Endourology. 37:316-322
ISSN: 1557-900X
0892-7790
DOI: 10.1089/end.2022.0396
Popis: Apart from the existing level-one evidence, few centers have reported on long-term outcomes after Holmium Laser Enucleation of the Prostate (HoLEP). Against this backdrop we aimed to report on our treatment experience and identify predictors of persistent/recurrent lower urinary tract symptoms (LUTS) after the procedure. Materialsmethods: From 2006-2017, 2,566 men underwent HoLEP at our institution. Only patients with available, cross-sectional follow-up (F/u) ≥6 months were included. Perioperative and F/u characteristics were compared by duration of F/u in months (quartiles). Multivariable logistic regression models (MVA) were employed to identify predictors of persistent/recurring symptoms, defined as International Prostate Symptom Score (IPSS)7 at F/u.774 patients with a median age of 70 years (IQR) 66-75), prostate volume of 80 ml (IQR 60-105), ASA score 2 (IQR 2-3), IPSS of 19 (IQR 14-24) and Quality of Life (QoL) of 4 (3-5) at the time of surgery were analyzed. Median F/u was 52 months (IQR 32-77), overall current median PSA was 0.91 mg/dl (0.5-1.8), median IPSS and QoL were 3 (IQR 1-7) and 1 (IQR 0-2), respectively. LUTS medication was present in 20 patients (2.6%), 15 (2%) patients required reoperation, permanent urinary incontinence was present in 17 (2.2%) of patients. On MVA age at surgery (OR) 1.04 (95%CI 1.01-1.07), p=0.013), prostate volume (OR 0.99 (95%CI 0.98-0.99),p=0.003), BMI (OR 1.06 (95%CI 1.0-1.1),p=0.043), presence of indwelling catheter (OR 0.51 (95%CI 0.32-0.82),p=0.004), and anticholinergics prior to surgery (OR 1.74 (95%CI 1.01-3.0),p=0.003) were predictors of persistent/recurring symptoms.Our HoLEP experience confirms durable and profound symptom relief in the vast majority men. A small fraction of patients complains about subjective persistent/recurring LUTS stressing the need for proper patient selection and timing of surgical intervention.
Databáze: OpenAIRE
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