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

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: To evaluate outcomes of post-holmium laser enucleation of the prostate (HoLEP) robot-assisted radical prostatectomy (RARP). Patients and Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)764-769
Number of pages6
JournalJournal of Endourology
Volume29
Issue number7
DOIs
StatePublished - Jul 1 2015

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Solid-State Lasers
Prostatectomy
Prostate
Reproductive Health
Neck Dissection
Neoplasm Grading
Robotics
Prostate-Specific Antigen
Urinary Bladder
Databases
Physicians
Biopsy

ASJC Scopus subject areas

  • Urology

Cite this

Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate : Feasibility and Evaluation of Initial Outcomes. / Gellhaus, Paul T.; Monn, M. Francesca; Leese, Joshua; Flack, Chandra K.; Lingeman, James E.; Koch, Michael O.; Boris, Ronald S.

In: Journal of Endourology, Vol. 29, No. 7, 01.07.2015, p. 764-769.

Research output: Contribution to journalArticle

Gellhaus, Paul T. ; Monn, M. Francesca ; Leese, Joshua ; Flack, Chandra K. ; Lingeman, James E. ; Koch, Michael O. ; Boris, Ronald S. / Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate : Feasibility and Evaluation of Initial Outcomes. In: Journal of Endourology. 2015 ; Vol. 29, No. 7. pp. 764-769.
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abstract = "Purpose: To evaluate outcomes of post-holmium laser enucleation of the prostate (HoLEP) robot-assisted radical prostatectomy (RARP). Patients and Methods: 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. Results: 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. Conclusions: 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.",
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