Holmium laser enucleation of the prostate (HoLEP) is recommended for the management of benign prostatic obstruction. With similar functional outcomes and less morbidity compared to transurethral resection of the prostate (TURP), it has become a useful tool in the armament of the urologist. However, until this study by Becker and colleagues there have been no published data about the use of HoLEP in the presence of known prostate cancer and concomitant lower urinary tract symptoms (LUTS). Traditionally such patients have undergone a channel TURP to minimise the morbidity associated with complete resection down to the capsule at the expense of lasting functional outcomes. The authors report the outcome of 62 patients with prostate cancer who underwent HoLEP for LUTS. Patients were stratified according to their prostate cancer treatment strategy setting into palliative, radiation, and surveillance groups and compared accordingly. Complications, functional outcomes and quality of life were assessed. Although median follow-up was short at 27 months, 90.3% of patients were voiding successfully, 17% had some degree of urinary incontinence and IPSS and maximal flow rate scores were improved significantly in all groups. Urgency and urinary incontinence was seen most commonly in patients who went on to have radiotherapy, although this was not a statistically significant finding. Independent of prostate size, HoLEP is feasible in patients with biopsy proven prostate cancer, in palliative patients as well as patients with less advanced disease, scheduled for radiotherapy or surveillance patients with bladder outlet obstruction. The study limitations include the retrospective nature and limited patient numbers. Taking the authors’ concept forward a randomised, controlled trial comparing safety, efficacy and oncological outcome of HoLEP and traditional TURP is necessary.
Results of HoLEP in patients with prostate cancer and LUTS
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