{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:41:22Z","timestamp":1791916882127,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 (&lt;5%) and blood loss were comparable to primary RP. Oncological outcomes were preserved, with positive surgical margin rates of 6\u201320% and biochemical recurrence rates of 7\u201315%, 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.<\/jats:p>","DOI":"10.3390\/cancers17223685","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:05:31Z","timestamp":1763463931000},"page":"3685","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate (HoLEP): A Systematic Review of Perioperative, Oncological, and Functional Outcomes"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-1544","authenticated-orcid":false,"given":"Stamatios","family":"Katsimperis","sequence":"first","affiliation":[{"name":"Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, 15126 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4619-9783","authenticated-orcid":false,"given":"Lazaros","family":"Tzelves","sequence":"additional","affiliation":[{"name":"Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, 15126 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titos","family":"Markopoulos","sequence":"additional","affiliation":[{"name":"Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, 15126 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0390-1467","authenticated-orcid":false,"given":"Themistoklis","family":"Bellos","sequence":"additional","affiliation":[{"name":"Department of Urology, Red Cross General Hospital of Athens, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4976-7608","authenticated-orcid":false,"given":"Konstantinos","family":"Douroumis","sequence":"additional","affiliation":[{"name":"First Department of Urology, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1972-0206","authenticated-orcid":false,"given":"Nikolaos","family":"Kostakopoulos","sequence":"additional","affiliation":[{"name":"First Department of Urology, Metropolitan General Hospital, 15562 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Skolarikos","sequence":"additional","affiliation":[{"name":"Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, 15126 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","first-page":"36","article-title":"HoLEP: The gold standard for the surgical management of BPH in the 21(st) Century","volume":"3","author":"Michalak","year":"2015","journal-title":"Am. 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Mak."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/22\/3685\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:23:01Z","timestamp":1763464981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/22\/3685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":32,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["cancers17223685"],"URL":"https:\/\/doi.org\/10.3390\/cancers17223685","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]}}}