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Impact of Detrusor Underactivity on Surgical Outcomes of Laser Prostatectomy: Comparison in Serial 12-Month Follow-Up Outcomes between Potassium-Titanyl-Phosphate Photoselective Vaporization of the Prostate and Holmium Laser Enucleation of the Prostate

  • Min Chul Cho,
  • Seung Beom Ha,
  • Juhyun Park,
  • Hwancheol Son,
  • Seung-June Oh,
  • Soo Woong Kim,
  • Jae-Seung Paick

Publication: Urology 2016 Feb 12

Objectives

To evaluate impacts of preoperative detrusor underactivity (DU) on outcomes of PVP or HoLEP for BPH, and to compare them between the two surgeries.

Methods
A total of 1,423 men, who underwent PVP (group A) or HoLEP (group B), were categorized into four groups: A1 (239 without DU), A2 (432 with DU), B1 (329 without DU) and B2 (423 with DU). DU was defined as bladder-contractility-index of <100. Outcomes were assessed at 1-, 3-, 6-, and 12-months postoperatively using IPSS, uroflowmetry and PSA. Successful outcome was defined as reductions by ≥50% of total-IPSS at 12-months postoperatively.

Results
In all four groups, almost all parameters of IPSS and uroflowmetry improved starting from 1-month. A1 or B1 had greater increases in maximum-flow-rate than A2 or B2. Decreases of total-IPSS in A2 were less than in A1 starting from 1-month after PVP, while those in B2 were less than those in B1 as late as 12-months after HoLEP. B2 showed greater improvements in maximum-flow-rate, subtotal-voiding-symptom-score, bladder-voiding-efficiency and total-IPSS than A2. In all patients, multivariate regression analysis revealed that the absence of DU, presence of bladder-outlet-obstruction and higher baseline total-IPSS were independent predictors of successful outcome after surgery, but the type of laser surgery (PVP vs. HoLEP) was not.

Conclusions
Our data suggest that micturition symptoms, maximum-flow-rate, bladder-voiding-efficiency and QOL improve starting from the early period after PVP or HoLEP, irrespective of DU. However, patients with DU may have less degree of improvement in micturition after PVP or HoLEP than those without DU.