Author Reply

Abstract

We appreciate the editorial comment and agree with the comments. 1 Griebling T.L. 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 (PVP) and holmium laser enucleation of the prostate (HoLEP) [Editorial Comment]. Urology. 2016; Google Scholar Underactive bladder is a common lower urinary tract dysfunction that is poorly understood and under-researched. 2 Osman N.I. Chapple C.R. Abrams P. et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014; 65: 389-398 Abstract Full Text Full Text PDF PubMed Scopus (248) Google Scholar Although the exact etiology of underactive bladder remains to be determined, a variety of pathophysiological processes including aging, bladder outlet obstruction (BOO), diabetes mellitus, neurologic disorders, and iatrogenic factors has been suggested as causative factors. 2 Osman N.I. Chapple C.R. Abrams P. et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014; 65: 389-398 Abstract Full Text Full Text PDF PubMed Scopus (248) Google Scholar , 3 Andersson K.E Bladder underactivity. Eur Urol. 2014; 65: 399-401 Abstract Full Text Full Text PDF Scopus (21) Google Scholar Thus, underactive bladder appears to be a multifactorial problem. In general, detrusor underactivity (DU) has been regarded as the most common pathophysiology of underactive bladder. 3 Andersson K.E Bladder underactivity. Eur Urol. 2014; 65: 399-401 Abstract Full Text Full Text PDF Scopus (21) Google Scholar Although the relationship between BOO and DU is incompletely understood, prolonged BOO is thought to be an important cause of DU. 2 Osman N.I. Chapple C.R. Abrams P. et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014; 65: 389-398 Abstract Full Text Full Text PDF PubMed Scopus (248) Google Scholar Because the impact of an increase in bladder outlet resistance on voiding can be more significant in men with both benign prostatic hyperplasia and DU, it has been suggested that a reduction of any degree of BOO can promote more efficient bladder emptying. However, although DU can be an important cause of lower urinary tract symptoms (LUTS) or decreased voiding efficiency even after BPH surgery, the impact of preoperative DU on surgical outcomes of BPH surgeries remains controversial. Thus, we evaluated the influence of preoperative DU on surgical outcomes of photoselective vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP) and compared it between PVP and HoLEP. Our study noted that micturition symptoms, urine flow rate, and voiding efficiency improved significantly starting from the early postoperative period after PVP or HoLEP, regardless of presence or absence of preoperative DU. However, the postoperative improvement in LUTS and urine flow rate in patients with DU were generally less pronounced than in those without DU after PVP or HoLEP. Also, in the subset of patients with DU, the improvement in LUTS, urine flow, rate and voiding efficiency after HoLEP was generally more pronounced than that after PVP. This may be attributed to the possibility that HoLEP removed prostatic adenoma more completely than PVP. Thus, our data may provide a clue to the causal relationship between BOO and DU, although further prospective, randomized, comparative studies are needed to draw a solid conclusion about it.