Effect of detrusor underactivity on short-term surgical prognosis of holmium laser enucleation in men with benign prostatic hyperplasia
Wu Yangyang1,2, Kaikai Lü1,2, Chang Xiao1,2, Zheng Baohui1,2, Ling Cunbao1, Wang Chunyang1,2, Yuan Qing1,2, Song Tao1,2,*
1 Graduate School, MedicalSchool of Chinese PLA, Beijing 100853, China; 2 Senior Department of Urology, the Third Medical Center of PLA General Hospital, Beijing 100039, China
Abstract：Objective: To investigate the effect of preoperative detrusor hypoactivity （DU） on the short-term prognosis of holmium laser enucleation of the prostate （HoLEP） in patients with benign prostatic hyperplasia （BPH）. Methods: Totally, 93 patients with BPH treated by HoLEP from January 2021 to February 2022 in Urology Department of our hospital were retrospectively analyzed. The patients were divided into DU group （n=37） and non-DU group （n=56） according to urodynamic examination results. Because of differences in clinical characteristics between the preoperative groups, the propensity score matching method （PSM） was used to match DU and non-DU groups in a ratio of 1：1. The maximum urinary flow rate （Qmax）, post-voiding residual urine volume （PVR）, International Prostate Symptom Score （IPSS） and quality of life （QOL） scores were compared between the two groups before and 3 months after surgery. Results: After PSM, patients in the BPH with DU group had Qmax[15.1 （8.8, 20.0） vs. 9.1 （5.5, 10.5） ml/s], PVR[（4.0, 0.0） vs. 30.0 （96.0, 16.0） ml], IPSS score [（133.0, 8.0） vs. 20.0 （5.0, 11.0）], QOL score [（18.0, 27.0） 2.0） vs. 5.0 （4.0, 5.0） scores were significantly improved （P<0.001）. After surgery [Qmax（15.1 （8.8, 20.0） vs 21.8 （13.2, 28.5） ml/s , P=0.009] and ΔQmax[（5.50, 2.0） vs. 12.9） ml/s, P=11.2] in the DU group were smaller than those in the non-DU group. There was no significant difference between the two groups in other postoperative and perioperative indexes （P>0.05）. Conclusion: Early micturition of patients with preoperative DU after HoLEP is less improved than that of patients without DU. In patients with BPH, timely surgical treatment before bladder secondary degeneration may be beneficial to protect detrusor function and achieve better postoperative outcomes.
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