Perioperative and functional outcomes of salvage versus primary Holmium laser enucleation of the prostate: Evidence-based on controlled studies

To evaluate the perioperative and functional outcomes of holmium laser enucleation of the prostate (HoLEP) among patients with and without prior transurethral prostate surgery. we performed a systematic search of the Cochrane Library, PubMed, Embase, Web of Science and Scopus databases for articles evaluating the effectiveness of salvage HoLEP (S-HoLEP) versus primary HoLEP (P-HoLEP) until January 2023. Nine studies involving 6044 patients were included for both quantitative and qualitative analysis. Compared with P-HoLEP, S-HoLEP used more energy (weighted mean difference = 14.27 KJ; 95% CI = 4.75-23.79; P = 0.003) and had an increased incidence of postoperative clot retention (odds ratio = 2.12; 95% CI = 1.25-3.59; P = 0.005) and urethral stricture (OR = 1.99; 95% CI = 1.04-3.8; P = 0.04). However, the International Prostate Symptom Score at the sixth month of follow-up was significantly lower for S-HoLEP than for P-HoLEP (WMD = -0.80; 95% CI = -1.38 to -0.22; P = 0.007). There was no significant difference between S-HoLEP and P-HoLEP in terms of operative time, enucleation time, enucleation efficiency, morcellation time, resected weight, catheterisation time, hospital stay duration, quality of life, maximum urinary flow rate, postvoid residual and intraoperative and postoperative overall complications. compared with P-HoLEP, S-HoLEP is still a feasible and effective method for treating residual benign prostatic hyperplasia, with only a slight increase in the probability of energy utilisation, clot retention and urethral stricture. Despite these minor discrepancies, the overall beneficial effects of the two modalities on symptom resolution is noteworthy.