Investig Clin Urol.  2016 Nov;57(6):431-436. 10.4111/icu.2016.57.6.431.

Predictors of urgency improvement after Holmium laser enucleation of the prostate in men with benign prostatic hyperplasia

• Hur WS
• Kim JC
• Kim HS
• Koh JS
• Kim SH
• Kim HW
• Cho SY
• Cho KJ

• KMID: 2451402
• DOI: http://doi.org/10.4111/icu.2016.57.6.431

Abstract

PURPOSE
To investigate the change in urinary urgency and predictors of urgency improvement after holmium laser enucleation of the prostate (HoLEP) in men with benign prostatic hyperplasia (BPH).
MATERIALS AND METHODS
We retrospectively analyzed the medical records of patients who were treated with HoLEP for BPH and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Those with prostate cancer diagnosed prior to or after HoLEP, a history of other prostatic and/or urethral surgery, moderate to severe postoperative complications, and neurogenic causes were excluded. Patients who had improved urgency with antimuscarinic medication after HoLEP were excluded. We divided the patients into 2 groups based on urgency symptoms 3 months after HoLEP: improved and unimproved urgency. Improved urgency was defined as a reduction of 2 or more points on the 5-point urinary sensation scale. Preoperative clinical and urodynamic factors as well as perioperative factors were compared between groups.
RESULTS
In total, 139 patients were included in this study. Voiding parameters in all patients improved significantly after HoLEP. Seventy-one patients (51.1%) had improved urgency, while 68 (48.9%) did not show any improvement. A history of acute urinary retention (AUR) and postvoid residual were associated with postoperative urgency improvement in univariate analysis. In multivariate analysis, a history of AUR was an independent factor affecting urgency improvement.
CONCLUSIONS
A preoperative history of AUR could influence the change in urgency after HoLEP surgery in patients with BPH.

Keyword

Holmium; Laser therapy; Overactive urinary bladder; Prostatic hyperplasia

MeSH Terms

Aged
Holmium
Humans
Lasers, Solid-State/*therapeutic use
Male
Middle Aged
Prognosis
Prostatic Hyperplasia/complications/pathology/physiopathology/*surgery
Psychometrics
Quality of Life
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Urinary Bladder, Overactive/etiology/physiopathology/*surgery
Urinary Retention/etiology/surgery
Urodynamics
Holmium

Reference

1. Peters TJ, Donovan JL, Kay HE, Abrams P, de la Rosette JJ, Porru D, et al. The International Continence Society "Benign Prostatic Hyperplasia" Study: the botherosomeness of urinary symptoms. J Urol. 1997; 157:885–889.

2. Djavan B. Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient's quality of life. Urology. 2003; 62:3 Suppl 1. 6–14.

3. Patra PB, Patra S. Research findings on overactive bladder. Curr Urol. 2015; 8:1–21.

4. Lin AT, Chen MT, Yang CH, Chang LS. Blood flow of the urinary bladder: effects of outlet obstruction and correlation with bioenergetic metabolism. Neurourol Urodyn. 1995; 14:285–292.

5. Tsujimura A, Takao T, Miyagawa Y, Okuda H, Yamamoto K, Fukuhara S, et al. Survey of overactive bladder symptoms influencing bother before and after treatment with tamsulosin hydrochloride in Japanese patients with benign prostatic hyperplasia. Urology. 2011; 78:1058–1062.

6. Wada N, Matsumoto S, Kita M, Hashizume K, Kakizaki H. Improvement of overactive bladder symptoms and bladder ischemia with dutasteride in patients with benign prostatic Enlargement. Low Urin Tract Symptoms. 2015; 7:37–41.

7. Zhao YR, Liu WZ, Guralnick M, Niu WJ, Wang Y, Sun G, et al. Predictors of short-term overactive bladder symptom improvement after transurethral resection of prostate in men with benign prostatic obstruction. Int J Urol. 2014; 21:1035–1040.

8. Hwang JC, Park SM, Lee JB. Holmium laser enucleation of the prostate for benign prostatic hyperplasia: effectiveness, safety, and overcoming of the learning curve. Korean J Urol. 2010; 51:619–624.

9. Kwon O, Lee HE, Bae J, Oh JK, Oh SJ. Effect of holmium laser enucleation of prostate on overactive bladder symptoms and urodynamic parameters: a prospective study. Urology. 2014; 83:581–585.

10. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2008; 179:5 Suppl. S87–S90.

11. Coyne KS, Margolis MK, Hsieh R, Vats V, Chapple CR. Validation of the urinary sensation scale (USS). Neurourol Urodyn. 2011; 30:360–365.

12. Verhamme KM, Dieleman JP, van Wijk MA, Bosch JL, Stricker BH, Sturkenboom MC. Low incidence of acute urinary retention in the general male population: the triumph project. Eur Urol. 2005; 47:494–498.

13. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997; 158:481–487.

14. Cho KJ, Kim HS, Koh JS, Han SB, Kim SH, Kim HW, et al. Preoperative factors affecting postoperative early quality of life during the learning curve of holmium laser enucleation of the prostate. Int Neurourol J. 2013; 17:83–89.

15. Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of prostate for patients in urinary retention. Urology. 2005; 66:789–793.

16. Anderson CB, Helfand BT, McVary KT. Holmium laser prostatic resection for patients presenting with acute urinary retention. BJU Int. 2008; 102:1623–1628.

17. Huang AJ, Brown JS, Boyko EJ, Moore EE, Scholes D, Walter LC, et al. Clinical significance of postvoid residual volume in older ambulatory women. J Am Geriatr Soc. 2011; 59:1452–1458.

18. Jin LH, Andersson KE, Han JU, Kwon YH, Park CS, Shin HY, et al. Persistent detrusor overactivity in rats after relief of partial urethral obstruction. Am J Physiol Regul Integr Comp Physiol. 2011; 301:R896–R904.

19. Schröder A, Chichester P, Kogan BA, Longhurst PA, Lieb J, Das AK, et al. Effect of chronic bladder outlet obstruction on blood flow of the rabbit bladder. J Urol. 2001; 165:640–646.

20. Wada N, Watanabe M, Kita M, Matsumoto S, Kakizaki H. Analysis of bladder vascular resistance before and after prostatic surgery in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Neurourol Urodyn. 2012; 31:659–663.

21. Fitzpatrick JM, Desgrandchamps F, Adjali K, Gomez Guerra L, Hong SJ, El Khalid S, et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012; 109:88–95.

22. McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe HL, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. 1998; 338:557–563.

23. Kumar V, Marr C, Bhuvangiri A, Irwin P. A prospective study of conservatively managed acute urinary retention: prostate size matters. BJU Int. 2000; 86:816–819.

24. Thomas K, Oades G, Taylor-Hay C, Kirby RS. Acute urinary retention: what is the impact on patients' quality of life? BJU Int. 2005; 95:72–76.