Holmium laser enucleation of the prostate as salvage therapy for benign prostatic obstruction after multiple prior surgical interventions

Abstract

Introduction: Recurrent benign prostatic obstruction (BPO) is a recognized complication following surgery. While Holmium laser enucleation of prostate (HoLEP) has been shown to be safe and effective as a salvage option after single procedure, outcomes in patients with multiple prior interventions remain poorly defined. This study aimed to evaluate the outcomes of HoLEP in patients with multiple prior BPO surgeries compared with surgery-naïve individuals.

Methods: We retrospectively reviewed all patients who underwent HoLEP between July 2017 and August 2025. Patients with two or more previous BPO interventions were identified and matched 1:2 with surgery-naïve controls based on age, prostate size, and anticoagulant/antiplatelet status. Baseline characteristics, postoperative outcomes were compared.

Results: Among 857 patients, 40 with ≥ 2 prior BPO procedures were matched to 72 surgery-naïve controls. Baseline characteristics were largely similar. The control group was significantly frailer with higher modified frailty index scores, lower hemoglobin, higher catheterization rates, and higher residual urine. Both groups experienced significant improvements in voiding. Study group showed more pronounced relief in long term IPSS, but the attrition was high in both groups. Operative time, length of stay, perioperative outcomes, complication rates, and recovery profiles did not differ significantly.

Conclusions: HoLEP appears to be a safe and effective treatment option for patients with a history of multiple BPO procedures, yielding functional outcomes and complication rates comparable to surgery-naive individuals. These findings support HoLEP as a viable salvage strategy even after multiple previous prostate surgeries. Nevertheless, the results should be interpreted considering the study's limited sample size, attrition, and the possibility of bias.

Bakbak H, Singh G, Abdelaziz A, Bhatia A, Velasquez Ospina J, Sharma ND, Fuentes AJ, Katz JE, Shah HN. Holmium laser enucleation of the prostate as salvage therapy for benign prostatic obstruction after multiple prior surgical interventions. World J Urol. 2026 Jul 3;44(1):479. doi: 10.1007/s00345-026-06539-2. PMID: 42397584; PMCID: PMC13331870.