Introduction: The 2021 American Urologic Association benign prostate hyperplasia (BPH) guideline recommends several minimally invasive surgical therapies (MIST). We look to describe outcomes of individuals undergoing holmium laser enucleation of the prostate (HoLEP) after failing prior minimally invasive BPH procedures, specifically prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), robotic waterjet treatment (RWT) or prostatic artery embolization (PAE). Methods: We retrospectively examined patients within our IRB approved clinical database that underwent HoLEP over a 19-month period (March 2021 – Oct 2022). Patient demographics, surgical BPH treatments, operative variables, and perioperative courses were examined. Patients with a prior neurological diagnosis or prior bladder cancer were excluded from the analysis. Descriptive statistics, two-tailed T-Tests, and ANOVA were performed with SPSS (p < 0.05). Although PAE is not an office-based procedure, due to its minimally invasive nature we included it in the MIST category. Results: We identified 600 HoLEP patients who met inclusion criteria, with 24.2% (n=145) of patients having undergone a prior BPH procedure. Of these procedures, 31.7% (n=46) were MISTs including PUL (n=22), WVTT (n=11), RWT (n=3), and PAE (n=10) and the remaining 68.3% (n=99) of procedures were TURP (n=63) and photo-selective vaporization of the prostate (PVP) (n=36). Time from original treatment to HoLEP did not differ between MIST procedures (p>0.05), but was significantly shortened comparing MISTs to TURP and PVP (2.9 versus 6.8 years, p<0.01). Patients with a prior BPH procedure were older (72.4 versus 69.7 years, p<0.01) than those without a history of BPH procedures; however, there were no other differences in pre-operative patient variables or post-operative functional outcomes including catheter free status, anti-cholinergic requirements, and continence rates, or 90-day complications (all p>0.05). Patients with a prior PUL had a significantly worse morcellation efficiency (7.3 vs 9.0 grams/min, p=0.03) and required more sets of morcellator blades per case (1.3 vs 1.0, p=0.03) compared to other prior BPH treatments. Conclusions: Patients undergoing HoLEP after prior failed BPH surgery experienced equivalent outcomes to patients without prior BPH surgery. Patient functional outcomes after HoLEP were maintained regardless of prior treatment modality. SOURCE OF Funding: None
