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Short Time Delay Between Previous Prostate Biopsy for Prostate Cancer Assessment and Holmium Laser Enucleation of the Prostate Correlates with Worse Perioperative Outcomes

By 12 April 2021No Comments

Pietro Piazza, Lorenzo Bianchi, Marco Giampaoli, Matteo Droghetti, Carlo Casablanca, Amelio Ercolino, Carlo Beretta, Dario Recenti, Eleonora Balestrazzi, Stefano Puliatti, Giuseppe Rosiello, Marco Amato, Daniele Romagnoli, Daniele D’Agostino, Caterina Gaudiano, Rita Golfieri, Angelo Porreca, Alexandre Mottrie, Riccardo Schiavina

Abstract

Background: No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes.

Objective: To evaluate the impact of time from PB to HoLEP on perioperative outcomes.

Design, setting, and participants: A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included.

Outcome measurements and statistical analysis: Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time.

Results and limitations: In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6-0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation.

Conclusions: The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time.

Patient summary: Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.

Keywords: Benign prostatic hyperplasia; Holmium laser enucleation of the prostate; Lower urinary tract symptoms; Prostate biopsy; Prostate cancer.

Copyright © 2021. Published by Elsevier B.V.

Stefano Puliatti

Stefano Puliatti

Il Dr. Puliatti si è laureato in Medicina e chirurgia nel 2012 presso l’Università degli Studi di Modena ed ha poi conseguito il titolo di specialista in Urologia con il massimo dei voti presso lo stesso Ateneo. Da Luglio 2019 ricopre il ruolo di Assistant Professor in Urologia presso l'Università di Modena e Reggio Emilia. Da Luglio 2019 ricopre anche il ruolo di Deputy Medical Director of ORSI Academy, Melle, Belgio e svolge attività clinica e chirurgica presso OLV (Onze Lieve Vrouwziekenhuis) Hospital in Aalst, Belgio (direttore: Prof. Alex Mottrie). La sua formazione si è incentrata in particolare sulla Chirurgia robotica e oncologica delle vie urinarie, avendo come principali campi di applicazione anche tumori e malattie della prostata, tumori del rene e delle alte vie urinarie, disturbi minzionali, calcolosi delle vie urinarie. È inoltre autore e coautore di articoli scientifici e capitoli di libro in ambito urologico. Attualmente svolge attività in libera professione presso diverse strutture situate a Modena e Provincia.