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Watanabe K, Otsuka A, Kitagawa Y, Sano A, Sato R, Matsushita Y, Watanabe H, Tamura K, Motoyama D, Ito T, Takada S, Miyake H. Preoperative factors predicting poor therapeutic efficacy of holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia. Low Urin Tract Symptoms 2024; 16:e12530. [PMID: 39011581 DOI: 10.1111/luts.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/27/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients. METHODS The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups. RESULTS The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB. CONCLUSIONS The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.
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Affiliation(s)
- Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichi Kitagawa
- Department of Urology, JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu, Japan
| | - Asuka Sano
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Sato
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Sanki Takada
- Department of Urology, JA Shinshiro Municipal Hospital, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Chuang MS, Ou YC, Cheng YS, Wu KY, Wang CT, Huang YC, Kao YL. Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery. Int Neurourol J 2024; 28:59-66. [PMID: 38569621 PMCID: PMC10990765 DOI: 10.5213/inj.2346252.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. METHODS We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. RESULTS The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. CONCLUSION In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.
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Affiliation(s)
- Ming-Syun Chuang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Yu Wu
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Te Wang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Chi Huang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kim SJ, Park SG, Pak S, Kwon O, Lee YG, Cho ST. Predictive factors for postoperative medication therapy for overactive bladder symptoms after holmium laser enucleation of prostate. Int J Urol 2023; 30:1036-1043. [PMID: 37522563 DOI: 10.1111/iju.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To preoperative factors that could predict the persisting storage symptoms after Holmium laser enucleation of the prostate (HoLEP). METHODS Medical records of 257 patients who underwent HoLEP between December 2014 and January 2021 were reviewed. Participants with a follow-up period exceeding 6 months were included. Preoperative data, including International Prostate Symptom Score (IPSS), uroflowmetry, prostate size, and prostate-specific antigen, were collected. All participants underwent a preoperative urodynamic study. The correlation between perioperative variables and postoperative medication therapy (antimuscarinics or beta-3 agonists) was assessed. RESULTS Out of 257 participants in the study, 46 (18.6%) were allocated to the medication group, of which 25 (54.3%) initiated medication therapy postoperatively. The medication group showed worse postoperative IPSS storage symptom score and quality of life score compared to the medication-free group (p = 0.048 and p = 0.002, respectively), but no significant differences were observed in complications or operative variables. In the de-novo medication group, patients had lower preoperative Qmax , larger prostate volume, and smaller maximum cystometric capacity (MCC) compared to the persisting medication group (p = 0.020, p = 0.009, and p = 0.008, respectively). Overactive bladder (OAB) history, terminal detrusor overactivity (DO), and IPSS urgency item were identified as possible predictive factors for post-HoLEP medication use. CONCLUSIONS Preoperative factors such as OAB history, terminal DO, and IPSS urgency item may predict the need for post-HoLEP medication therapy. Further follow-up studies are warranted to understand the characteristics of the de-novo medication group due to the significant discomfort it can cause to patients.
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Affiliation(s)
- Sung Jin Kim
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Gon Park
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sahyun Pak
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ohseong Kwon
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Rieken M, de Nunzio C, Cornu JN, Ramasamy R, Misrai V, Malde S, Oelke M, Gacci M, Madersbacher S. Medical Treatment Incidence and Persistence After Surgical Relief of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: A Critical Analysis of the Literature. Eur Urol Focus 2023:S2405-4569(23)00193-1. [PMID: 37758614 DOI: 10.1016/j.euf.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT The incidence and risk factors for persisting pharmacotherapy following surgical treatment of benign prostatic obstruction (BPO) remain unclear. OBJECTIVE To evaluate the evidence on persisting pharmacotherapy of lower urinary tract symptoms (LUTS) following surgical treatment of BPO. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PROSPERO ID CRD42022310598). PubMed and EMBASE databases were searched in February 2022, with an updated search in October 2022. Studies evaluating pharmacotherapy in men aged >18 yr following surgical treatment of BPO were included. EVIDENCE SYNTHESIS Overall, ten nonrandomized studies and one post hoc analysis of two randomized controlled trials were included. The incidence of persisting medical treatment or medical retreatment varied strongly between time points and investigated surgical techniques. Among the investigated techniques, most data were available for transurethral resection of the prostate (TURP). Persistence of pharmacotherapy after TURP at 6 mo ranged from 8.7% to 57% for the use of alpha-blockers. The use of 5-alpha reductase inhibitors after TURP ranged from 5.5% at 6 mo to 19% at 6-24 mo, whereas the use of antimuscarinics ranged from 3.4% to 28.1% at 6 mo. Data on initiation of pharmacotherapy after TURP also differed between study and type of medication. At 12 yr, the use of alpha-blockers after TURP ranged from 12% to 38%. The risk factors associated with medication after BPO surgery were age, history of diabetes mellitus, history of cerebrovascular accident, preoperative medication use, as well as surgical techniques other than laser enucleation of the prostate. CONCLUSIONS Pharmacotherapy for LUTS is common after BPO surgery. The outcomes following different surgical techniques are heterogeneous, with limited data from randomized controlled trials. Future studies on surgical treatment of BPO should include the use of LUTS-related pharmacotherapy after BPO surgery as a secondary endpoint. PATIENT SUMMARY In the present systematic review, we investigated the risk of ongoing or novel therapy with drugs following surgery for benign prostate enlargement. We found that a non-negligible proportion of men will need to take drug therapy after surgery. Certain risk factors can be identified, which are associated with a higher risk of drug therapy after surgery.
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Affiliation(s)
- Malte Rieken
- alta uro AG, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Cosimo de Nunzio
- U.O.C. di Urologia, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | | | | | | | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthias Oelke
- Department of Urology, Prostate Center North-West, St. Antonius-Hospital, Gronau, Germany
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Huang MM, Dean NS, Assmus MA, Lee MS, Guo JN, Krambeck AE. Intradetrusor OnabotulinumtoxinA Injections at the Time of Holmium Laser Enucleation of the Prostate for Men with Severe Storage Symptoms. J Endourol 2023; 37:801-806. [PMID: 37053094 DOI: 10.1089/end.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Introduction: Intradetrusor onabotulinumtoxinA (OTA) injection is a well-established treatment option for refractory overactive bladder; however, its use at the time of holmium laser enucleation of the prostate (HoLEP) for men with bladder outlet obstruction (BOO) and severe storage symptoms has not been previously reported. Materials and Methods: We retrospectively identified men with BOO and severe storage symptoms who underwent treatment with 200 U of intradetrusor OTA (Botox®) at the time of HoLEP. Patients were propensity score matched to a cohort of HoLEP-only patients based on age, Michigan Incontinence Symptom Index (M-ISI) score, preoperative urinary retention, urge incontinence, and prostate size. Perioperative, postoperative, and patient-reported outcomes were examined between groups. Results: We identified 82 men who underwent HoLEP, including 41 patients in the OTA group and 41 patients in the control group. There was no difference in operative times (59 minutes OTA vs 55 minutes control, p = 0.2), rates of same-day trial of void (TOV) (92% OTA vs 94% control, p = 0.7), or rates of same-day discharge (88% OTA vs 85% control, p = 0.6) between groups. There was no difference in temporary postoperative urinary retention (7% OTA vs 2% control, p = 0.3) between groups. Patients who received OTA injections had a significant reduction in their incontinence scores at 3-month follow-up (M-ISI -8, interquartile range [IQR]: -13 to 0, p < 0.001), whereas control patients did not (M-ISI -5, IQR: -8 to -1, p = 0.2). There was no difference in rates of 90-day complications between groups (OTA 10% vs control 5%, p = 0.7). Conclusions: Intradetrusor OTA at the time of HoLEP is safe and is associated with improved urinary incontinence scores and AUA Symptom Score. Rates of same-day discharge and same-day TOV after HoLEP were not affected by OTA. These findings support the role of OTA as an adjunct to surgical intervention in men with incontinence in the presence of BOO.
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Affiliation(s)
- Mitchell M Huang
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicholas S Dean
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark A Assmus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, University of Calgary, Calgary, Canada
| | - Matthew S Lee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - Jenny N Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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6
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Takeuchi Y, Sawada Y, Watanabe S, Ni-Itsu Y, Sekido N. Age-specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score. Low Urin Tract Symptoms 2023; 15:38-49. [PMID: 36507559 DOI: 10.1111/luts.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB). METHODS A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated. RESULTS The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427). CONCLUSIONS In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.
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Affiliation(s)
- Yasuharu Takeuchi
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshitomo Sawada
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shoutarou Watanabe
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuo Ni-Itsu
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
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Yoo S, Jeong H, Son H, Oh SJ, Paick JS, Cho MC. Does Preoperative Bladder Compliance Affect Long-Term Functional Outcomes after Laser Prostatectomy? World J Mens Health 2023:41.e35. [PMID: 37118952 DOI: 10.5534/wjmh.220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/26/2022] [Accepted: 01/23/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE We assessed the effects of preoperative bladder compliance on the long-term functional outcomes, especially focused on postoperative storage symptom changes, after laser prostatectomy. MATERIALS AND METHODS From January 2008 to March 2014, 1,608 men who underwent laser prostatectomy, including holmium laser enucleation or photo-vaporization of the prostate, were included in the analysis. We divided patients into 3 groups according to bladder compliance on a baseline urodynamic study: <12.5, 12.5-25, ≥25 mL/cmH2O. A multivariable analysis was performed to determine the impact of bladder compliance on changes in long-term functional outcomes after laser prostatectomy. RESULTS Bladder compliance was less than 12.5 mL/cmH2O in 50 (3.1%), 12.5-25 mL/cmH2O in 232 (14.4%) patients. As bladder compliance decreased, the baseline International Prostate Symptom (IPSS) total score and storage sub-score were increased; the voiding sub-score remain unchanged. At postoperative 12 and 36 months, absolute improvements in the IPSS total score and storage sub-score were higher in <12.5 mL/cmH2O group compared to other groups, although those were equivalent at postoperative 1 months. On the multivariable analysis, decreased bladder compliance <12.5 mL/cmH2O was significantly associated with superior improvement in storage sub-score at postoperative 36 months, although it was not associated with voiding sub-score. CONCLUSIONS In patients with preoperative bladder compliance <12.5 mL/cmH2O, storage symptoms could be further improved at 36 months after laser prostatectomy compared to others. Thus, laser prostatectomy could be a considerable treatment option for patients with severely decreased bladder compliance.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Mediplex Sejong Hospital, Incheon, Korea
| | - Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
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8
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Risk Factors for Transurethral Coagulation for Hemostasis During Holmium Laser Enucleation of the Prostate. Int Neurourol J 2022; 26:153-160. [PMID: 35793994 PMCID: PMC9260329 DOI: 10.5213/inj.2142414.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/01/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We aimed to identify risk factors for transurethral coagulation (TUC) using bipolar electrocautery for hemostasis during holmium laser enucleation of the prostate (HoLEP) surgery for benign prostatic hyperplasia (BPH). METHODS We analyzed the clinical outcomes of HoLEP surgery performed by a single surgeon between January 2010 and April 2020 at the Seoul National University Hospital. Patient characteristics and perioperative parameters were used to identify the risk factors for TUC. The TUC group was defined as a case of conversion to hemostasis using electrocautery during the hemostasis step after enucleation. RESULTS Of 1,563 patients, 357 underwent TUC (TUC group; 22.8%) as an adjuvant (n=299, 19.1%) or salvage (n=58, 3.7%) therapy. Patients in the TUC group were older (mean±standard deviation, 70.6±7.3 years vs. 69.3±7.0 years; P=0.002), had more 5-alpha reductase inhibitor (5-ARI) use (35.6% vs. 25.9%, P<0.001), higher serum prostate-specific antigen (PSA) (5.4 ±4.8 ng/mL vs. 3.8 ±4.5 ng/mL, P <0.001), larger total prostate volume (TPV) (89.5 ±44.7 mL vs. 66.0 ±32.6 mL, P<0.001), and larger transitional zone volume (TZV) (57.3±34.9 mL vs. 37.7±24.2 mL, P<0.001) than those who did not undergo TUC (non-TUC group). In univariate logistic regression analysis, age, 5-ARI use, PSA, TPV, and TZV correlated with TUC, whereas in multivariate logistic regression analysis, only TZV was associated with TUC. The odds ratios (ORs) of TUC were analyzed per TZV quartile. Compared to TZV<22.3 mL, the OR was 2.42 in 34.1 mL≤TZV<53.5 mL (95% confidence interval [CI], 1.58-3.72; P<0.001), 5.17 in ≥53.5 mL (95% CI, 3.44-7.77; P<0.001). CONCLUSION The risk of TUC during HoLEP surgery increases in patients with TZV >35 mL. Therefore, TUC may be potentially necessary in patients with a large transition zone volume in patients with BPH.
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9
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Yao HH, Hoe V, Crump RT, Sengupta S, O'Connell HE, Carlson KV, Baverstock RJ. Impact of radical prostatectomy on bladder function as demonstrated on urodynamics study-A systematic review. Neurourol Urodyn 2021; 40:582-603. [PMID: 33476072 DOI: 10.1002/nau.24606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 01/13/2023]
Abstract
AIMS This study aims to describe the effects of radical prostatectomy (RP) on bladder function by performing a systematic review of urodynamics study findings before and after RP. METHODS This systematic review was conducted in accordance with the PRISMA guideline and registered on PROSPERO (CRD42020206844). A systematic search was conducted using PubMed, Cochrane, and Embase. Studies were included if they involved men who underwent RP and had urodynamics study performed preoperatively, postoperatively, or both. Studies that included only subgroups of patients based on symptoms were excluded. Three hundred and four articles were screened, with 20 articles included. A qualitative analysis was performed. RESULTS The rate of baseline bladder outlet obstruction (BOO) pre-RP was 19%-67%. All six studies with comparative data pre- and postoperatively demonstrated a decrease in the rate of patients with equivocal or clear obstruction. The baseline rates of detrusor overactivity (DO) varied widely from 11% to 61.2%. Six of eight studies with 6 months or more follow-up showed an improvement in the rates of DO ranging from 3.0% to 12.5%. The rate of de novo DO ranged from 0% to 54.5%. Four studies reported an increased rate of impaired bladder contractility and two of three studies showed a worsening rate of impaired bladder compliance following RP. This review is limited by the absence of level I/II studies. CONCLUSIONS Urodynamics study shows that BOO is improved following RP in most patients. RP resolves DO in some patients and cause de novo DO in others. The net effect is a reduced overall rate of DO in most studies. Bladder compliance and contractility may be impaired after RP.
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Affiliation(s)
- Henry H Yao
- Department of Urology, Western Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Vesia (Alberta Bladder Centre), Southern Alberta Institute of Urology, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Venetia Hoe
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Robert T Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helen E O'Connell
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Kevin V Carlson
- Vesia (Alberta Bladder Centre), Southern Alberta Institute of Urology, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Richard J Baverstock
- Vesia (Alberta Bladder Centre), Southern Alberta Institute of Urology, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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10
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Lee HY, Cho SY, Juan YS, Teoh JYC. How to optimise urinary continence in anatomical endoscopic enucleation of the prostate? Andrologia 2020; 52:e13621. [PMID: 32400034 DOI: 10.1111/and.13621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The traditional transurethral resection of the prostate (TURP) is considered as gold-standard surgical treatment to relieve symptoms resulting from bladder outlet obstruction by prostate enlargement. However, with the advances of novel laser technologies and more experienced surgeon conquering the steep learning curve, anatomical endoscopic enucleation of prostate (AEEP) has become a more popular alternative surgical technique. Although AEEP has compatible functional outcome, less blood loss, shorter catheterisation duration and hospital stay, the risk of post-operative urinary incontinence (UI) is often an issue of concern. In this review, we focus on discussion about risk factors related to increased incidence of UI, some surgical tips to avoid damaging external urinary sphincter and treatment strategies to facilitate recovery of urinary continence after surgery.
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Affiliation(s)
- Hsiang Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Yao W, Wu F, Zhang D, Zheng X, Xu H, Zhou X, Wan W, Chen S. Impacts of preoperative maximum detrusor pressure on minimally invasive surgery effect on patients with benign prostatic hyperplasia. MINERVA CHIR 2019; 75:25-29. [PMID: 30600962 DOI: 10.23736/s0026-4733.18.07880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aims to investigate the impacts of preoperative maximum detrusor pressure (Pdet.max) on minimally invasive surgery effect on patients with benign prostatic hyperplasia. METHODS The clinical data of a total of 156 patients receiving minimally invasive surgery for benign prostatic hyperplasia in Hospital of Nanchang Institute of Medical Sciences from August 2014 to June 2017 were retrospectively reviewed and summarized. The patients were divided into three groups according to different Pdet.max in the urodynamic examination results before the surgery, namely, group A (Pdet.max <50 cmH2O), group B (50≤ Pdet.max <90 cmH2O) and group C (Pdet.max ≥90 cmH2O). The International Prostate Symptom Score (IPSS) and Quality-of-Life score (QOLS) were compared. RESULTS Compared with those in group A, the IPSS and QOLS of the patients in group B and group C at 1 month, 3 months and 12 months after the surgery were decreased notably (all P<0.05). Moreover, the IPSS and QOLS of the patients in group C were obviously lower than those in group B (all P<0.05). CONCLUSIONS The results indicated that as the preoperative Pdet.max was increased, the symptoms of the patients receiving minimally invasive surgery for benign prostatic hyperplasia were ameliorated more significantly, and the patients had higher quality of life. The preoperative Pdet.max can judge the treatment effect of minimally invasive surgery on the patients with benign prostatic hyperplasia and help to guide the patients' prognosis. The greater the preoperative Pdet.max is, the better the treatment effect of the patients after the surgery will be, and the higher the quality of life will be.
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Affiliation(s)
- Wenliang Yao
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Feihua Wu
- Department of Gynecology, Jiangxi Provincial Hospital of traditional Chinese Medicine, Nanchang, China
| | - Duanjun Zhang
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Xiaoting Zheng
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Heping Xu
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Xiaopi Zhou
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Wenyuan Wan
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China
| | - Shenghui Chen
- Department of Andrology, Hospital of Nanchang Institute of Medical Sciences, Nanchang, China -
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Cornwell LB, Smith GE, Paonessa JE. Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate: 12 Months Follow-Up. Urology 2018; 124:213-217. [PMID: 30528716 DOI: 10.1016/j.urology.2018.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify pre- and perioperative factors associated with incontinence after holmium laser enucleation of the prostate for benign prostatic hyperplasia. METHODS Retrospective review of our single-surgeon database identified 88 patients with 12 months' follow-up who underwent surgery between December 2014 and November 2016. Postoperative urinary incontinence was defined as 1 or more pads per day. Patients were evaluated at 6 weeks, 6 months, and 12 months postoperatively. RESULTS Preoperative variables associated with incontinence at all follow-ups included pre-existing incontinence and higher detrusor voiding pressure. Higher maximum urinary flow and lower postvoid residual were predictors of transient urinary incontinence. On multivariate analysis, pre-existing incontinence remained significant as a 12-month predictor, whereas a higher detrusor voiding pressure was only significant as a 6-week predictor. De novo incontinence at 12 months was identified in only 1/44 patients (2%). Among patients with pre-existing incontinence, 30/40 (75%) reported resolution of their incontinence at 12 months. Numerous demographic, urinary, urodynamic, and operative factors were not significant for predicting incontinence. The mean decrease in pads per day between 6 weeks and 6 months was -1.6 and between 6 months and 12 months was -0.75. Medical management did not significantly impact rates of postoperative incontinence when compared to observation alone. CONCLUSION Pre-existing urinary incontinence and/or higher detrusor voiding pressure may predict urinary incontinence 12 months after holmium laser enucleation of the prostate.
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Affiliation(s)
- Laura B Cornwell
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
| | - Garrett E Smith
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
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Park IN, Kim TB. Second to fourth digit ratio and lung function (forced vital capacity): predictors of maximum urinary flow rate after holmium laser enucleation of the prostate. Andrology 2018; 7:172-177. [PMID: 30450730 DOI: 10.1111/andr.12564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maximum urinary flow rate (Qmax) is usually increased after holmium laser enucleation of the prostate (HoLEP). However, improvements vary between patients and results regarding potential predictors of Qmax after HoLEP are inconsistent. Thus, we investigated pre-operative variables including second to fourth digit ratio (digit ratio) and pulmonary function test (PFT) findings as potential predictors of Qmax after HoLEP. METHODS One hundred and ninety-five consecutive patients with benign prostatic hyperplasia (BPH) who underwent HoLEP were enrolled. Before HoLEP, PFTs were performed and lengths of second and fourth digits of right hands were measured by a single investigator using a digital vernier caliper. To identify independent predictors of Qmax after HoLEP, univariate and multivariate analyses were performed using linear regression models. RESULTS Mean age and total prostate volume for all 195 study subjects were 69.4 years and 63.3 mL respectively. Mean pre-operative and post-operative Qmax values were 8.7 and 26.2 mL/sec respectively. Univariate analysis showed age (r = -0.181, p = 0.014), digit ratio (r = 0.213, p = 0.004), lung function (forced vital capacity (FVC): r = 0.218, p = 0.005; forced expiratory volume in 1 sec (FEV1): r = 0.166, p = 0.034), pre-operative Qmax (r = 0.264, p = 0.000), pre-operative voided volume (VV) (r = 0.158, p = 0.033), and post-operative VV (r = 0.311, p = 0.000) were associated with post-operative Qmax, whereas multivariate analysis showed that digit ratio (β = 0.285, p = 0.001), FVC (β = 0.340, p = 0.039), and post-operative VV (β = 0.301, p = 0.000) independently predicted post-operative Qmax. CONCLUSIONS The independent predictors of Qmax after HoLEP were digit ratio and lung function (FVC) as well as post-operative VV. This means that the higher a man's digit ratio and lung function (FVC), the higher his Qmax after HoLEP.
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Affiliation(s)
- I-N Park
- Department of Pulmonology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - T B Kim
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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[Impact of medical and surgical treatments of LUTS on nocturia]. Prog Urol 2018; 28:848-855. [PMID: 30268350 DOI: 10.1016/j.purol.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Nocturia is the most frequently reported lower urinary tract symptom, but the impact of medical and surgical treatments on this symptom remains poorly evaluated. The objective of this work was to carry out a systematic review of the literature on the medical and surgical management of nocturia in men with bladder outlet obstruction due to benign prostatic hyperplasia. MATERIAL AND METHOD A systematic review of the literature was conducted including the effects of medical and surgical treatments on nocturia. Articles were selected by 3 independent reviewers before being analyzed and synthesized. RESULTS Among medical treatments, the most effective on nocturia seems to be desmopressin. Nevertheless, prescribing restrictions to men under 65 years of age hinder its use in routine practice. The effect of other medical treatments remains modest, although significant compared to placebo groups. The decrease in the number of nocturia would decrease from 0.25 to 0.7 in placebo group and from 0.29 to 1.1 in active treatment groups (alpha blocker, diuretic, anti-inflammatory, IPDE-5, 5 alpha reductase inhibitor). Surgical treatments seem to be more effective on nocturia. Although persistent in half of the patients undergoing surgery, the number of nocturia episodes decreased in 70% of them. CONCLUSION Nocturia is one of the most common urinary symptoms and the one that responds the least to the proposed medical and surgical treatments. The information given to patients by urologists must emphasize the modest effects to be expected in this area.
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Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis. World J Urol 2018; 37:529-538. [PMID: 30006907 DOI: 10.1007/s00345-018-2402-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/05/2018] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the effect of urodynamic detrusor overactivity (DO) on the outcomes of transurethral surgery in patients with male bladder outlet obstruction (BOO). MATERIALS AND METHODS We systematically searched the PubMed, Embase, and Cochrane Library databases for articles published between January 1989 and June 2017. All results of eligible studies were synthesized. RESULTS Nine articles met the eligibility criteria. These studies included a total of 932 patients with a median number of 92 patients per study (range 40-190). Of the nine studies, the conventional transurethral prostatectomy was adopted in four studies, photoselective vaporization of prostate in three studies, and other surgical modalities in two studies. In patients with DO positive, the pooled mean difference (MD) was not significant for a better or poorer improvement in the International Prostate Symptom Score [pooled MD, - 0.27; 95% confidence interval (CI), - 1.75 to 1.22; studies, 9; participants, 827], quality-of-life score (pooled MD, - 0.14; 95% CI, - 0.46 to 0.18; studies, 7; participants, 734), maximal flow rate (pooled MD, 0.79; 95% CI, - 1.57 to 3.14; studies, 8; participants, 781), and post-void residual volume (pooled MD, 2.81; 95% CI, - 4.70 to 10.32; studies, 6; participants, 509) compared to patients with DO negative. Some comparisons showed between-study heterogeneity despite the strict criteria of the eligible studies. However, there was no clear evidence of publication bias in the funnel plots. CONCLUSIONS Our meta-analysis results demonstrated that preoperative urodynamic DO has no diagnostic role in the prediction of surgical outcomes in patients with male BOO.
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Li BK, Chen BS, Xin YH, Liu CX, Zheng SB, Xu YW, Li HL, Zou Y, Li LP. Can the lower urinary tract storage symptoms be completely resolved after plasmakinetic enucleation of the prostate? Asian J Androl 2018; 19:655-658. [PMID: 27924790 PMCID: PMC5676424 DOI: 10.4103/1008-682x.193161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to determine whether the lower urinary tract storage symptoms of benign prostatic obstruction (BPO) could be completely resolved after plasmakinetic enucleation of the prostate (PKEP) and the possible predictors of persistent symptoms. Two hundred and sixty-seven cases of BPO performed PKEP from July 2008 to June 2009 were retrospectively analyzed. Five-year postoperative data were collected and compared with the preoperative data. According to the urodynamic results, the patients were divided into involuntary detrusor contraction (IDC) group (n = 95) and no IDC group (n = 172) preoperatively; the patients with IDC were divided into IDC-persistent group (n = 33) and IDC-resolved group (n = 62) after PKEP. The predictors of persistent IDC were analyzed. Compared with the preoperative data, the 5-year postoperative data showed that the IDC rate was lower (P = 0.000), Overactive Bladder Symptom Score (OABSS) was lower (P = 0.000), maximum cystometric capacity (MCC) was larger (P = 0.000), Prostate volume (PV) was smaller (P = 0.000), and prostate-specific antigen (PSA) was lower (P = 0.000). Compared with the no IDC group, the IDC group showed that the age was older (P = 0.016), MCC was smaller (P = 0.004), PSA was higher (P = 0.016), and Chronic Inflammation rate was higher (P = 0.004). Compared with IDC-resolved group after PKEP, IDC-persistent group showed that the age was older (P = 0.019), MCC was smaller (P = 0.000), PSA was higher (P = 0.013), and Chronic Inflammation rate was higher (P = 0.032). The present study shows that the storage symptoms are still needed to be focused on after PKEP. The advanced patient age, MCC, PSA, and chronic inflammation may be the important clinical predictors of persistent IDC.
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Affiliation(s)
- Bing-Kun Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Bin-Shen Chen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yu-Hong Xin
- Department of Urology, The People's Hospital of Jiangmen, Jiangmen 529020, China
| | - Chun-Xiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Shao-Bo Zheng
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Ya-Wen Xu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Hu-Lin Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yong Zou
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Li-Ping Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Long-Term Outcomes of Laser Prostatectomy for Storage Symptoms: Comparison of Serial 5-Year Followup Data between High Performance System Photoselective Vaporization and Holmium Laser Enucleation of the Prostate. J Urol 2018; 199:1591-1599. [DOI: 10.1016/j.juro.2018.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/23/2022]
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Pyun JH, Kang SG, Kang SH, Cheon J, Kim JJ, Lee JG. Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non-neurogenic bladder dysfunction. Kaohsiung J Med Sci 2017; 33:458-463. [DOI: 10.1016/j.kjms.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
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Hur WS, Kim JC, Kim HS, Koh JS, Kim SH, Kim HW, Cho SY, Cho KJ. Predictors of urgency improvement after Holmium laser enucleation of the prostate in men with benign prostatic hyperplasia. Investig Clin Urol 2016; 57:431-436. [PMID: 27847917 PMCID: PMC5109790 DOI: 10.4111/icu.2016.57.6.431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Won Sok Hur
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Sin Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hoon Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Woo Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Yeon Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Jun Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons' Experience During Learning Curve. Int Neurourol J 2016; 20:59-68. [PMID: 27032559 PMCID: PMC4819156 DOI: 10.5213/inj.1630396.198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/19/2015] [Indexed: 11/16/2022] Open
Abstract
Purpose: To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP) according to surgeon experience (beginner or experienced) and preoperative clinical data. Methods: Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO). We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (<21 cases) and experienced (≥21 cases). Results: Our statistical data showed DO was a significant predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000). Additionally, patient age, surgeon mentorship (inverse correlation), and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively). With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse) at the super-short period, and patient age and mentorship (inverse correlation) at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively) were significant predictive factors for beginners, and first desire to void (FDV) at 1 month after HoLEP (OR, 1.009; P=0.012) was a significant predictive factor for experienced surgeons in multivariate analysis. Conclusions: Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient’s quality of life with regards to urinary continence.
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Is benign prostatic obstruction surgery indicated for improving overactive bladder symptoms in men with lower urinary tract symptoms? Curr Opin Urol 2016; 26:17-21. [DOI: 10.1097/mou.0000000000000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of Detrusor Overactivity on Functional Outcomes After Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Obstruction. Urology 2015; 86:133-8. [DOI: 10.1016/j.urology.2015.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 11/22/2022]
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Raskolnikov D, Friedman FM, Etwaru DJ, Weiss JP. The evaluation and management of persistent nocturia. Curr Urol Rep 2014; 15:439. [PMID: 25007892 DOI: 10.1007/s11934-014-0439-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nocturia, or waking at night to void, is a common symptom that leads to substantial morbidity. Men and women are both affected across a wide age range, such that the objective evaluation of nocturia remains a challenge, due largely to its multifactorial etiology. While for some patients, nocturia is caused by common structural conditions such as prostatic obstruction, for others it is due to a complex interplay between multiple underlying systemic diseases. For this reason, persistent nocturia merits particularly careful consideration. The purpose of this review is to describe the most recent salient research in the field of nocturia, with a particular emphasis on its evaluation and management.
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Affiliation(s)
- Dima Raskolnikov
- Department of Urology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA,
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