Effect of preoperative detrusor underactivity on long-term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: A lesson from five-year serial follow-up data.

To investigate the impact of preoperative DU on serial treatment outcomes during five years after photovaporization (PV) or holmium laser enucleation (HoLEP) in BPH patients, to compare its impact between PV and HoLEP, and to identify predictors of long-term lower urinary tract symptoms (LUTS) improvement.

This study involved 245 BPH patients with complete 5-year follow-up data (PV using 120W-HPS: 143, HoLEP: 102), grouped as follows: PV-HPS-DU(+) (n = 114), PV-HPS-DU(-) (n = 29), HoLEP-DU(+) (n = 56) and HoLEP-DU(-) (n = 46). Bladder contractility index (BCI) < 100 was regarded as DU. Serial treatment outcomes for the International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry, and serum PSA level at 6 months, and at 1, 2, 3, 4, and 5 years after surgery, were compared among the groups. LUTS improvement was defined as a reduction in total IPSS of ≥ 50% relative to baseline.

Improvement of total IPSS, quality of life (QOL) index and post-void residual urine volume (PVR) in PV-HPS-DU(+) and PV-HPS-DU(-) groups were maintained up to 5 years after PV, except for maximum flow rate (Qmax) and bladder voiding efficiency (BVE). In HoLEP-DU(+) and HoLEP-DU(-) groups, improvements in all outcome parameters were maintained up to 5 years after HoLEP. Deterioration of subtotal voiding symptom score, total IPSS, and Qmax with time during the long-term period after surgery were more pronounced in PV-HPS-DU(+) and HoLEP-DU(+) groups than PV-HPS-DU(-) and HoLEP-DU(-) groups. Reduction of subtotal voiding symptom score, total IPSS, QOL index, and serum PSA were greater in the HoLEP-DU(+) group than in the PV-HPS-DU(+) group throughout follow-up. The type of surgery (HoLEP vs. PV) and higher baseline BCI were independent predictors of LUTS improvement at 5-years after surgery.

Generally, improvement of micturition symptoms, QOL and PVR in patients with DU appears to be maintained up to 5 years after PV or HoLEP. Deterioration of voiding symptoms and urine flow rate at long-term follow-up visits after PV or HoLEP is more pronounced in LUTS/BPH patients with DU than those without DU. BPH patients with DU may benefit from more complete removal of prostatic adenoma by HoLEP and greater baseline bladder contractility in terms of micturition symptoms and QOL. This article is protected by copyright. All rights reserved.

BJU international. 2018 Dec 24 [Epub ahead of print]

Min Chul Cho, Sangjun Yoo, Juhyun Park, Sung Yong Cho, Hwancheol Son, Seung-June Oh, Jae-Seung Paick

Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea., Department of Urology, Seoul National University College of Medicine, Seoul, Korea.