SUFU 2020: Change of Nocturia Before and After HoLEP: A Prospective Study

Scottsdale, Arizona ( This study investigates changes in nocturia and its relevance to other clinical factors in patients with benign prostatic hyperplasia (BPH), before & after holmium laser enucleation of the prostate (HoLEP). Nocturia is one of many features of BPH and it is known to be one of the most resistant symptoms to improve after surgery.

There were 420 patients enrolled in this study and registered in the prospective BPH registry from September 2016 to November 2018. Evaluation before treatment included pre-operative transrectal ultrasonography (TRUS) and urodynamic studies (UDS). Questionnaires, including the International prostate symptoms score (IPSS), overactive bladder symptom score (OABSS), Nocturia Quality of Life (N-QOL) and Pittsburgh sleep quality index in Korean (PSQI-K), frequency volume chart (FVC), uroflowmetry, and postvoid residual volume were taken pre-operatively as well as post-operatively at two weeks, three months and six months. The relationship between the parameters of nocturia and pre-operative clinical parameters was examined.

Post-operative Q-max and PVR of 420 patients (mean age 68.4±7.7 years, SD) were significantly improved (p<0.001). The mean frequency of nocturnal voiding was measured pre-operatively and post-operatively at two weeks, three months and six months. In IPSS, these were 2.3 (±1.4), 2.1 (±1.3), 1.6 (±1.0) and 1.4 (±0.8) (p<0.001), pre-operative and two weeks, three months and six months postoperatively, respectively. In OABSS they were 2.0 (±1.1), 1.9 (±1.1), 1.5 (±0.9) and 1.3 (±0.8) (p<0.001), showing a similar decrease in the frequency of nocturnal voiding. With FVC, they were 1.4 (±0.9), 1.7 (±1.3), 1.2 (±0.9), 1.1 (±0.8) (p<0.001). The total volume of nocturnal urine recorded in FVC significantly decreased from 551.9 (±274.6) mL before surgery to 518.4 (±216.2) mL at the post-operative six months (p=0.031). The maximal voided volume also significantly increased from 356.2 (±175.6) mL before surgery to 390.3 (±128.3) mL at postoperative six months (p<0.001). Significant reduction in the frequency of nocturnal voiding at postoperative six months was observed in patients with a greater first desire to void volume measured in the pre-operative UDS, the greater maximal voided volume and less nocturia volume recorded in the pre-operative FVC (p<0.001). A decrease in the frequency of nocturnal voiding was significantly associated with an increase in maximal voided volume (r=-0.271, p=0.002) and a decrease in the volume of nocturnal urine (r=0.462, p<0.001).

The authors concluded that the frequency of nocturnal voiding after HoLEP operation was significantly lower compared to the pre-operative period. This reduction in the frequency of nocturnal voiding is thought to have significantly attributed to the increase in the maximal voided volume recorded in FVC.

parameters of study

Presented by: Hwanik Kim, MD, Seoul National University Hospital, Seoul, South Korea

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; Twitter: @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - 29, 2020, Scottsdale, AZ