MP27-04 GIVING UNDERACTIVE BLADDERS A SECOND CHANCE: HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH DETRUSOR UNDERACTIVITY.

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-04 GIVING UNDERACTIVE BLADDERS A SECOND CHANCE: HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR MANAGEMENT OF LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH DETRUSOR UNDERACTIVITY. Garrett Smith, Dongliang Wang, and Jessica E. Paonessa Garrett SmithGarrett Smith More articles by this author , Dongliang WangDongliang Wang More articles by this author , and Jessica E. PaonessaJessica E. Paonessa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms (LUTS) in men are classically attributed to bladder outlet obstruction (BOO). However, LUTS may also exist in the presence of detrusor underactivity (DU). Evaluation of the voiding phase in patients with BOO demonstrates high bladder pressures and low flow rates. In contrast, low bladder pressures and low flow rates are characteristic of patients with DU. Holmium laser enucleation of the prostate (HoLEP) has been shown to be a safe, durable and effective surgical treatment for BOO secondary to benign prostatic enlargement (BPE) in prostates of any size. In our early experience, we have identified a population of patients with DU and BPE who have benefitted from HoLEP. We compared patients with BOO to those with DU to determine if outcomes after HoLEP are comparable. METHODS Our HoLEP database was retrospectively reviewed, identifying 84 patients with preoperative (preop) urodynamic studies (UDS) who underwent HoLEP with or without bladder neck incision (+/- BNI). Of these patients, 24 had UDS consistent with DU; defined as max flow rate (Qmax) < 15 ml per second and detrusor pressure (Pdet) < 40 cm water. The remaining 60 patients had BOO (Qmax < 15 and Pdet ≥ 40). International Prostate Symptom Score and Sexual Health Inventory for Men questionnaires were administered preop and at each postoperative (postop) visit. All surgeries were performed by a single surgeon, supervising residents, from December 2014 to September 2016. RESULTS There were no differences (p > 0.05) in patient demographics, catheter dependence, preop questionnaires and incontinence, enucleation/morcellation time, tissue volume removed and length of hospital stay between the two groups. Patients with DU had higher preop post void residual (PVR) (p = 0.017) and lower Qmax (p = 0.007). There were no differences in postop questionnaires and incontinence at 6 weeks, 6 months (mo) and 12 mo. PVRs were higher in DU patients at 6 weeks (p = 0.012), but not at 6 and 12 mos. All patients were able to void after HoLEP. One patient with DU was self catheterizing once nightly at 6 mo follow up. CONCLUSIONS The standard treatment for patients with DU and urinary retention is catheterization (clean intermittent or chronic indwelling). Typically, these patients are not offered surgery. For patients who can Valsalva and stand to void, HoLEP +/- BNI may improve quality of life and allow them to be catheter free. These findings may also support expanding the indications for HoLEP. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e329 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Garrett Smith More articles by this author Dongliang Wang More articles by this author Jessica E. Paonessa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...