MP71-10 PREDICTORS OF PROSTATE CANCER IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA

Abstract

INTRODUCTION AND OBJECTIVES: The purpose of this study was to assess functional and QoL outcomes associated with various forms of benign prostatic hyperplasia (BPH) surgical treatment using an independent third party survey center. METHODS: An independent third party survey center was employed to send a comprehensive questionnaire to all patients who underwent surgical intervention for BPH at our institution between Jan. 2007 to Jan. 2013. Patients were identified using Current Procedural Terminology codes and our institutional billing records. Overall satisfaction, urinary and sexual functional outcomes were evaluated as part of this survey. After IRB approval, the validated instruments were Sexual Health Inventory for Men (SHIM), the International Prostate Symptoms Score (IPSS) and the International Continence Society e Short Form questionnaires (ICSmaleSF). Overall SHIM, IPSS and ICS scores were analyzed as were the individual domains in each questionnaire, comparing them individually and as a function of specific procedure. RESULTS: There were 906 patients who underwent BPH surgery at our institution during the study interval. Of the 862 alive patients, there were 479 respondents (55.6%). Among responders there were 214 Holmium Laser Enucleation of the Prostate (HoLEP), 210 Transurethral Resection of the Prostate (TURP), 21 Holmium Laser Ablation of the Prostate, 18 Photoselective Vaporization, 9 transurethral Incision of the Prostate and 7 simple prostatectomy. Preoperatively, patient reported continence rates as 55.3%, 58.2%, 71.4%, 57.1%, 66.7% and 80%, respectively (P1⁄4 0.651). Postoperatively, there were no significant differences in SHIM scores. However, total IPSS varied significantly among procedures (p<0.0001). Mean ( SD) IPSS was lowest for simple prostatectomy 4.0 ( 2.6) followed by HoLEP 5.8 ( 5.4). When Individual domains were analyzed, there were significant differences in intermittency (p1⁄40.0004), weak stream (p1⁄40.0029), straining (p< 0.0001) and quality of life QoL (p1⁄40.001). In all domains HoLEP had the lowest scores. Regarding ICSmaleSF, there was a significant difference in favor of TURP in the incontinence domain(p<0.0001) and in favor of HoLEP in the voiding (p1⁄40.0192) and QoL domains (p1⁄40.0344).The majority of the patients were satisfied with their intervention, regret was least in HoLEP 64.1% (p1⁄40.0175). CONCLUSIONS: Patients were generally satisfactied. However, those who underwent a HoLEP tended to have the best functional outcomes and highest QoL scores.