Presented by: Jonas Herrmann MD
University Medical Centre Mannheim

Introduction

Prostate biopsy (PBx) may be necessary prior to surgical treatment of benign prostatic enlargement if there is suspicion of prostate cancer. It has been a matter of academic debate whether PBx influences the results of holmium laser enucleation of the prostate (HoLEP). Therefore, our aim was to analyse perioperative outcomes and complication rates in patients following HoLEP with vs. without previous PBx in a high volume center.

Materials

Perioperative data and 30-day complication rates of 524 patients receiving HoLEP from 01/2021 to 01/2023 were analysed from a prospective database. Complications were recorded and evaluated using the Clavien Dindo Classification (CDC) and the Comprehensive Complication Index (CCI). The cohort was divided into patients who received PBx 6 months prior to HoLEP (group A) vs. patients who received PBx > 6 months prior to HoLEP or did not receive PBx at all (group B).

Results

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The median prostate volume in group A (N = 76) was 100 cm³, which was greater than in group B (N = 448), which was 80 cm³ (p = 0.0431). Significant bacteriuria prior to HoLEP was more common in group A than in group B. (51.3 % vs. 27.7 %, p < 0.0001). Group A patients were younger (median 66 years vs. 72 years, p< 0.0001) and had higher preoperative PSA levels (7.5 ng/mL vs. 4.2 ng/mL, p < 0.0001). Enucleation efficiency (1.73 g/min vs. 1.8 g/min, p = 0.868), median hemoglobin drop (1 g/l vs. 0.8 g/l, p = 0.521), and median hospital stay (2 days in both groups) did not differ significantly between groups. Intraoperative complications occurred in 1.32 percent of group A patients versus 1.34 percent of group B patients (p = 1.00).

Conclusion

Prostate biopsy within 6 months of HoLEP did not show an effect on perioperative outcomes or complications, both intra- and postoperatively. Patients who received PBx 6 months before surgery had a larger prostate volume, a higher pre-operative PSA, were younger, and significant bacteriuria was observed more frequently.

Funding

No funding was received. 

Lead Authors

Friedrich Hartung, MD
University Medical Centre Mannheim

Co-Authors

Britta Grüne, MD
University Medical Centre Mannheim

Maren J Wenk, MD
University Medical Centre Mannheim

Paul Patroi, MD
University Medical Centre Mannheim

Marie-Claire Rassweiler-Seyfried, PD. Dr.
University Medical Centre Mannheim

Maximilian C Kriegmair, Prof. Dr.
University Medical Centre Mannheim

Maurice S Michel, Prof. Dr.
University Medical Centre Mannheim