Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes

Paul T Gellhaus; M Francesca Monn; Joshua Leese; Chandra K Flack; James E Lingeman; Michael O Koch; Ronald S Boris

doi:10.1089/end.2014.0767

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Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes

Journal article

Peer reviewed

Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes

Paul T Gellhaus, M Francesca Monn, Joshua Leese, Chandra K Flack, James E Lingeman, Michael O Koch and Ronald S Boris

Journal of endourology, Vol.29(7), pp.764-769

07/2015

DOI: 10.1089/end.2014.0767

PMID: 25423412

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Abstract

To evaluate outcomes of post-holmium laser enucleation of the prostate (HoLEP) robot-assisted radical prostatectomy (RARP). Using an institutional database, we identified 11 HoLEP patients who subsequently underwent RARP. These were matched 1:2 to RARP patients without a previous transurethral surgical procedure. Variables matched were age, pre-RARP prostate-specific antigen level, and biopsy Gleason score. Urinary continence and sexual function were evaluated by physician questioning, American Urological Association symptom score, and Sexual Health in Men (SHIM) scores. Descriptive statistics were used to compare cohorts. RARP pathologic outcomes were similar between cases and controls. Twenty-seven percent of previous HoLEP patients reached strict urinary continence (leak free, pad free) at last follow-up compared with 64% of matched controls (P=0.071). The average (range) SHIM score at last follow-up was 2.6 (1-5) for previous HoLEP patients compared with 13.9 (5-20) (P<0.001). The posterior bladder neck and apical dissections were significantly more challenging in the setting of previous HoLEP and necessitated a low threshold for wider resection to minimize positive surgical margins. Post-HoLEP RARP is challenging but preliminarily appears safe and feasible when performed by an experienced robotic surgeon. Patients should be counseled regarding expectations of urinary continence and sexual function in this setting.

Holmium - therapeutic use

Robotic Surgical Procedures - methods

Prostatectomy - methods

Urinary Bladder Neck Obstruction - etiology

Urinary Bladder Neck Obstruction - surgery

Humans

Middle Aged

Male

Treatment Outcome

Prostate-Specific Antigen - analysis

Feasibility Studies

Prostatic Hyperplasia - complications

Prostatic Hyperplasia - surgery

Lasers, Solid-State

Laser Therapy - methods

Aged

Details

Title: Subtitle: Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes
Creators: Paul T Gellhaus - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
M Francesca Monn - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
Joshua Leese - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
Chandra K Flack - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
James E Lingeman - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
Michael O Koch - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
Ronald S Boris - Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
Resource Type: Journal article
Publication Details: Journal of endourology, Vol.29(7), pp.764-769
Publisher: United States
DOI: 10.1089/end.2014.0767
PMID: 25423412
ISSN: 0892-7790
eISSN: 1557-900X
Language: English
Date published: 07/2015
Academic Unit: Urology
Record Identifier: 9984051506302771

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