TOPLINE

Holmium laser enucleation of the prostate (HoLEP) appears to be a safe and effective option for patients with recurrent benign prostatic obstruction (BPO) who underwent at least two previous surgeries; patients who underwent prior procedures had functional outcomes and complication rates comparable with those with no history of prostate surgery.

METHODOLOGY

• Researchers used data from a prospectively maintained registry to compare outcomes in patients who underwent prior procedures for BPO with those who were surgery-naive; all patients received HoLEP.
• They retrospectively analyzed data of 857 patients at a tertiary academic center between July 2017 and August 2025; 40 patients (mean age, 72.08 years) had recurrent or persistent BPO after at least two prior interventions; 72 matched control individuals (mean age, 72.32 years) had never undergone prostate surgery.
• Prior BPO procedures included transurethral resection of the prostate, photoselective vaporization, prostatic urethral lift, and water vapor thermal therapy.
• Patients were put under general anesthesia in the lithotomy position using the en-bloc enucleation technique. A high-volume surgeon performed or supervised the surgeries.
• Postoperative functional outcomes included changes in the severity of lower urinary tract symptoms, tracked using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and postvoid residual (PVR) urine volume, with assessments at 6 weeks and 3, 6, and 12 months.

TAKEAWAY

• At baseline, patients without prior prostate surgery were more vulnerable and had greater frailty, higher rates of catheter dependence, lower preoperative hemoglobin levels, and higher PVR urine volumes (P < .05 for all) than those with a history of multiple BPO procedures.
• Operative time, resected volume, length of hospital stay, and catheter duration were similar between groups, with no intraoperative complications reported.
• Both groups experienced substantial improvements in outcomes with comparable function regardless of procedural history. The long-term improvement in IPSS was more pronounced in the study group, although analysis was limited by the small sample.
• The rates of major and minor complications remained low and were similar between groups, with no significant differences in the rates of transfusion, urethral stricture, bladder neck contracture, or urinary incontinence.

IN PRACTICE

“There is often concern that repeated transurethral surgeries may lead to distorted anatomy, urethral compromise, and technically challenging endoscopic conditions that could predispose to inferior outcomes or even procedural failure. Despite substantial prior instrumentation, functional recovery, perioperative safety, and complication rates were comparable to those in surgery-naive patients, supporting HoLEP as a definitive option even after multiple earlier procedures,” the researchers wrote.

SOURCE

The study was led by Hasim Bakbak of the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine in Miami. It was published online on July 3, 2026, in World Journal of Urology.

LIMITATIONS

The study used a retrospective design and included patients from a single center. The number of patients with multiple prior BPO procedures was small. Researchers could not determine whether outcomes varied by the type of prior BPO procedure.

DISCLOSURES

The study did not receive any grants. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.