The Role of Holmium Laser Enucleation of the Prostate in Reducing the Risk of Bladder Cancer Recurrence and Progression

Background: Bladder outlet obstruction (BOO) and urinary retention were recognized contributing factors to bladder cancer (BCa) recurrence and progression due to prolonged urothelial exposure to carcinogens, chronic inflammation, and incomplete bladder emptying. Holmium laser enucleation of prostate (HoLEP) is a minimally invasive and highly effective procedure that completely removes obstructive prostatic tissue, thus resolving BOO. To explore the HoLEP impact on BCa recurrence and progression by improving voiding dynamics and reducing post-void residual (PVR). Materials and Methods: We carried out a retrospective case-control study, based on a multicenter prospectively maintained database, on 100 consecutive male patients (cases) with a first diagnosis of non-muscle-invasive bladder cancer, with BOO and urinary retention and treated with HoLEP (in case of at least 3-months of timor-free status). The cases were compared with 200 patients (controls) with same baseline characteristics but not treated with HoLEP. We evaluated PVR, International Prostatic Symptoms Score-IPSS, BCa recurrence and progression rates. The t-Test, χ2-test, logistic correlations, multivariate analysis were applied to evaluate the association between the BOO resolution and urinary retention by HoLEP and BCa recurrence and progression. Results: Patients treated with HoLEP showed a significant PVR reduction compared with controls (p < 0.01). The HoLEP group demonstrated statistically significant improvements in IPSS scores, indicating better urinary symptom control. The rates of recurrence and progression were significantly lower in the HoLEP-treated group (p < 0.01). Multivariate analysis identified the BOO resolution by HoLEP as an independent predictor of reduced BCa recurrence (odds ratio 0.65, 95% CI 0.45-0.85, p < 0.001). The control group exhibited persistently elevated PVR and higher rates of BCa recurrence and progression. Conclusions: Urinary retention could represent a prognostic factor of treatment response, and its active treatment by HoLEP should be considered as an important therapeutic step in the clinical management of patients with BCa.