Impact of Prior Holmium Laser Enucleation of the Prostate on Outcomes After Robot-Assisted Radical Prostatectomy

Purpose We evaluated the perioperative, oncologic, and continence outcomes of robot-assisted radical prostatectomy (RARP) in patients with and without prior holmium laser enucleation of the prostate (HoLEP). Methods We reviewed 419 RARP cases, including 27 patients with prior HoLEP, and performed 1:2 propensity score matching. Urinary continence was assessed longitudinally using pad counts at scheduled intervals, with 12-month continence as the primary endpoint. Secondary endpoints included perioperative outcomes and biochemical recurrence (BCR). Results Perioperative outcomes, pathological findings, and BCR-free survival were comparable between patients with and without prior HoLEP. At 12 months, functional continence (≤ 1 pad/day) was achieved in 100.0% of patients without prior HoLEP and in 85.2% of those with prior HoLEP (p = 0.011). Kaplan–Meier analysis demonstrated no significant difference in time to recovery (log-rank p = 0.068); however, a subset of patients with prior HoLEP experienced persistent incontinence beyond 12 months. Exploratory analyses implied an association between longer adjunctive transurethral coagulation time during HoLEP and worse functional continence. Conclusions Prior HoLEP did not compromise perioperative safety or oncologic outcomes after RARP; however, it was associated with a lower 12-month functional continence rate in a subset of patients. Post-enucleation anatomical changes should be considered during surgical planning and preoperative counseling.