Background: The widespread adoption of holmium laser enucleation of the prostate (HoLEP) has led to a growing number of men subsequently diagnosed with localized prostate cancer requiring radical prostatectomy (RP). However, anatomical alterations after HoLEP may increase surgical complexity and affect outcomes. This systematic review aimed to synthesize current evidence on perioperative, oncological, and functional outcomes of RP following HoLEP.Methods: A systematic literature search was conducted in PubMed, CENTRAL, and ClinicalTrials.gov through to September 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251134483). Eligible studies included patients undergoing RP after HoLEP with reported perioperative, oncologic, or functional data. Methodological quality was assessed using the ROBINS-I tool, and results were synthesized narratively.Results: Eight retrospective studies comprising 202 patients were included. RP after HoLEP was technically feasible across open, laparoscopic, and robotic approaches. Operative time and the need for bladder-neck reconstruction were increased, reflecting post-enucleation fibrosis, but major complication rates (<5%) and blood loss were comparable to primary RP. Oncological outcomes were preserved, with positive surgical margin rates of 6–20% and biochemical recurrence rates of 7–15%, similar to those of primary RP. Functional recovery, particularly urinary continence, was slower initially but generally equivalent at 12 months. Erectile function outcomes were variable but satisfactory when nerve-sparing was feasible.Conclusions: Radical prostatectomy after HoLEP is a technically demanding yet safe procedure that achieves oncologic and long-term functional outcomes comparable to primary prostatectomy. Prior HoLEP should not preclude curative surgical management of prostate cancer, provided the operation is performed by experienced surgeons in high-volume centers.
背景：钬激光前列腺剜除术（HoLEP）的广泛应用导致越来越多男性术后被诊断为局限性前列腺癌，需接受根治性前列腺切除术（RP）。然而，HoLEP术后的解剖结构改变可能增加手术复杂性并影响预后。本系统综述旨在综合当前关于HoLEP术后RP围手术期、肿瘤学及功能结局的证据。 方法：根据PRISMA 2020指南（PROSPERO CRD420251134483），在PubMed、CENTRAL和ClinicalTrials.gov数据库中进行系统性文献检索，截止时间为2025年9月。纳入标准为报道HoLEP术后接受RP患者的围手术期、肿瘤学或功能数据的研究。采用ROBINS-I工具评估方法学质量，并对结果进行叙述性综合。 结果：共纳入8项回顾性研究，涉及202例患者。HoLEP术后RP在开放、腹腔镜及机器人手术中均具备技术可行性。手术时间及膀胱颈重建需求有所增加，反映了剜除术后纤维化改变，但主要并发症发生率（<5%）与出血量与初次RP相当。肿瘤学结局得以保持，手术切缘阳性率为6–20%，生化复发率为7–15%，与初次RP相似。功能恢复（特别是尿控功能）初期较慢，但12个月时总体相当。勃起功能结局存在差异，但在可行保留神经手术时结果令人满意。 结论：HoLEP术后根治性前列腺切除术技术要求较高但仍属安全，其肿瘤学结局及长期功能结果与初次前列腺切除术相当。只要由高手术量中心的经验丰富外科医生实施手术，既往HoLEP史不应成为前列腺癌根治性手术治疗的障碍。
肿瘤(癌症)患者之家