Does Cystolitholapaxy at the Time of Holmium Laser Enucleation of the Prostate Affect Outcomes

Objective To compare the outcomes of men undergoing holmium laser enucleation of the prostate (HoLEP) with and without concurrent holmium laser cystolitholapaxy (HLC). Patients and Methods A retrospective review of a prospectively maintained database was performed on patients who underwent HoLEP: Group 1 (N = 279) and HoLEP with concurrent HLC: Group 2 (N = 41) between June 2008 and July 2015. Patient characteristics and outcomes were compared. Results The average bladder stone burden was 3.6 cm. Preoperative characteristics were similar. Not surprisingly, group 2 had longer operative times (172 minutes vs 146 minutes, P  = .01) (Table 1) whereas postvoid residual was slightly higher than in group 1 at 6-week follow-up (30 mL vs 52 mL, P  = .04). This difference was not clinically significant. Group 2 had a higher rate of early urinary incontinence (UI) (26.8% versus 12.5%, P  = .03) (Table 3); however, only 2 patients in the entire cohort experienced long-term UI. Otherwise, outcomes including blood loss, urinary symptom scores, flow rates, and complication rates were similar between the 2 groups. Conclusion This is the largest series of HoLEP with concurrent HLC studied. Patients undergoing concurrent HoLEP and HLC can be counseled that although there is nearly a 30% rate of UI immediately following surgery, they can likely expect complete resolution by 3-6 months. Holmium laser treatment should be considered in all patients with benign prostatic hyperplasia with bladder outlet obstruction and bladder stones, as this multimodality tool treats both pathologies, and results in excellent outcomes.