What are the recurrence and failure rates of laser surgery for benign prostatic hyperplasia (BPH)?

From the Guidelines

Laser surgery for benign prostatic hyperplasia (BPH) has recurrence and failure rates ranging from 5-20% within 5-10 years after the procedure, depending on the specific laser technique used. The most common reasons for failure include incomplete tissue removal during the initial procedure, continued prostate growth over time, or development of scar tissue 1.

Factors Influencing Recurrence and Failure Rates

• Incomplete tissue removal during the initial procedure
• Continued prostate growth over time
• Development of scar tissue
• Natural progression of BPH, especially in younger men with larger prostates at the time of initial treatment

Treatment Options for Recurrence

• Repeat laser surgery
• Switching to a different surgical approach like transurethral resection of the prostate (TURP)
• Managing symptoms with medications such as alpha-blockers (tamsulosin 0.4mg daily) or 5-alpha reductase inhibitors (finasteride 5mg daily or dutasteride 0.5mg daily) 1

Reducing Recurrence Risk

• Following post-operative instructions carefully
• Attending all follow-up appointments
• Maintaining a healthy lifestyle
• Avoiding medications that can worsen urinary symptoms (like decongestants and certain antihistamines)
• Reporting any new urinary symptoms promptly

It is essential to note that the recurrence risk is related to the natural progression of BPH, as the remaining prostate tissue can continue to grow, especially in younger men with larger prostates at the time of initial treatment 1.

From the Research

Recurrence and Failure Rates of Laser Surgery for BPH

• The recurrence and failure rates of laser surgery for benign prostatic hyperplasia (BPH) have been studied in several research papers 2, 3, 4, 5, 6.
• A study published in 2022 found that the symptom recurrence rate after Holmium laser enucleation of the prostate (HoLEP) was 22% at 60 months, with redo surgery needed for 4.4% of patients 3.
• Another study published in 2022 reported a cumulative incidence of reintervention for persistence or regrowth of prostate adenoma (ReIP) of 5.6% at 10 years after Thulium laser enucleation of the prostate (ThuLEP) 4.
• A 2021 study found that 26% of patients were symptomatic at 10-year follow-up after HoLEP, with older patients and those who never recovered full continence postoperatively at higher risk of symptom recurrence 5.
• A comparative effectiveness study published in 2019 found that tissue-eliminating transurethral prostate procedures, including laser prostatectomy, were associated with higher medication discontinuation rates and lower resumption and initiation rates compared to tissue-necrosing procedures 6.
• The studies suggest that laser surgery for BPH can provide durable symptom relief, but recurrence and failure rates vary depending on factors such as patient age, prostate size, and surgical technique 3, 4, 5.

Predictors of Symptom Recurrence

• Preoperative peak flow rate, post-void residual volume, and International Prostate Symptom Score (IPSS) have been identified as predictors of symptom recurrence after laser surgery for BPH 3.
• Older patients and those who never recovered full continence postoperatively are at higher risk of symptom recurrence at long-term follow-up 5.
• Enucleation weight ≥60 g was a significant predictor of reintervention for persistence or regrowth of prostate adenoma (ReIP) after ThuLEP 4.

Long-term Outcomes

• HoLEP and ThuLEP have been shown to provide durable symptom relief and low reintervention rates at long-term follow-up 3, 4, 5.
• The cumulative incidence of reintervention for ReIP and long-term complications (ReIC) at 10 years after ThuLEP was estimated at 5.6% and 3.4%, respectively 4.
• Consistent symptom relief is preserved even 10 years after HoLEP in almost 75% of patients, with older age and incomplete continence recovery after surgery being risk factors for symptom recurrence at long-term follow-up 5.