Prior HoLEP association with longer operative time and catheter duration in subsequent RARP
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Key Takeaway
Consider prior HoLEP as a factor increasing operative time and catheter duration, but not oncological risk, in subsequent RARP.
This systematic review and meta-analysis evaluated the impact of prior holmium laser enucleation of the prostate (HoLEP) on outcomes following robot-assisted radical prostatectomy (RARP). The analysis included data from three retrospective comparative studies, comprising 63 patients who underwent RARP after HoLEP and 322 patients who underwent RARP without prior HoLEP. The primary outcomes assessed included surgical metrics, postoperative recovery, pathological findings, oncological results, and functional recovery.
Patients with prior HoLEP demonstrated statistically significantly longer operative times compared to the non-HoLEP group, with a weighted mean difference of 31.99 minutes (p < 0.001). Additionally, the likelihood of requiring bladder neck reconstruction was substantially higher in the prior HoLEP cohort, with an odds ratio of 9.90 (p < 0.001). Recovery metrics were also affected, as the time to catheter removal was longer by a weighted mean difference of 0.48 days (p = 0.003).
In contrast to the surgical and recovery metrics, no differences were reported between the two groups regarding pathological, oncological, or functional outcomes. Specifically, rates of positive surgical margins, tumor stage, biochemical recurrence, postoperative continence, and sexual function recovery were comparable. No specific adverse events or tolerability data were reported in the included studies.
The authors note that the inclusion of only three retrospective studies and the small cohort of 63 post-HoLEP patients limit the statistical power and generalizability of the findings. Consequently, while prior HoLEP appears to increase surgical complexity and immediate recovery time, it does not appear to negatively affect oncological control or functional recovery after RARP. Clinicians should be aware of these potential intraoperative and postoperative challenges when managing patients with this history.
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View Original Abstract ↓
BACKGROUND: The prevalence of incidental prostate cancer (iPCa) after holmium laser enucleation of the prostate (HoLEP) ranges from 5% to 20%. The hypothesis is that prior HoLEP may complicate the treatment of such cancers with RARP and negatively impact post-RARP functional outcomes.
METHODS: In February 2025, PubMed®, Scopus®, and Web of Science™ were assessed to retrieve data of men with PCa undergoing RARP (P) after HoLEP (I), compared to those without prior HoLEP (C). The outcomes of interest included surgical results (O) from retrospective and prospective comparative studies (Studies). Surgical intra- (OT, EBL, number of nerve-sparing RARP and bladder neck reconstruction), and postoperative (LOS, time to catheter removal), pathological (PSM and tumor stage), oncological (BCR), and functional (postoperative continence and sexual function recovery) outcomes were meta-analyzed, using WMD for continuous variables and odd ratio (OR) for dichotomous variables.
RESULTS: After study selection, three comparative retrospective studies were included in the SR and MA, comprising 63 patients undergoing RARP after HoLEP and 322 patients who underwent RARP. Compared to patients who underwent RARP without prior HoLEP, patients undergoing RARP after HoLEP had a statistically significantly longer OT (WMD: 31.99 minutes, < 0.001), higher likelihood of bladder neck reconstruction (OR: 9.90, < 0.001), and longer time to catheter removal (WMD: 0.48 days, = 0.003). However, no differences in terms of pathological, oncological, and functional outcomes were reported between the two groups. The main limitation relates to the inclusion of only three retrospective comparative studies and the small cohort of post-HoLEP patients, which limits the statistical power and generalizability of the findings.
CONCLUSION: Prior HoLEP may introduce certain surgical challenges, reflected in longer OT, a greater need for bladder neck reconstruction, and a longer time to catheter removal. However, these procedural differences do not appear to affect oncological or functional outcomes after RARP.
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