Nonspecific genitourinary pain improves after prostatectomy using holmium laser enucleation of prostate in patients with benign prostatic hyperplasia: a prospective study.

Sung Han Kim,Seung-June Oh,Robert Hurst

doi:10.1371/journal.pone.0098979

Sung Han Kim, Seung-June Oh + Show 1 more

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https://doi.org/10.1371/journal.pone.0098979

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Abstract

ObjectiveTo investigate changes in nonspecific genitourinary discomfort or pain (GUDP) before and after holmium laser enucleation of prostate (HoLEP). GUDP associated with lower urinary tract symptoms (LUTS) is a common complaint among benign prostatic hyperplasia (BPH) patients, but very little is known about this clinical entity.MethodsFrom February 2010 to August 2011, 100 HoLEP patients with complete clinical data at a single institution were enrolled in the study to analyze the degree of GUDP with a visual analog scale (VAS) from 0 to 10 points at baseline and at 3 and 6 months postoperatively, and to investigate any relationships between GUDP and urodynamics, uroflowmetry, and scores from the International Prostate Symptom Score (IPSS) questionnaire.ResultsFifty-six patients had LUTS only, while the remaining 44 had both LUTS and GUDP. Pain was located in the suprapubic (42.0%), perineal/penile (33.0%), back (17.0%), and perianal (8.0%) regions. During the post-operative period, at six months, the VAS, IPSS, peak flow rate and post-void residual volume had improved significantly in 44 GUDP patients (p<0.010). GUDP had completely resolved in 40 (90.9%) patients and had decreased in four (9.1%) patients, while seven (12.5%) patients developed GUDP with voiding in the urethral and perineal areas by the third month postoperatively. When compared to patients with complete resolution, those with persistent GUDP were found to have a significantly higher preoperative presence of bladder outlet obstruction (BOO) as an independent risk factor (OR 6.173, 95% CI 1.132–1.323).ConclusionBoth GUDP and LUTS improved significantly after HoLEP. Patients with significant preoperative BOO tended to have persistent GUDP after surgery.

Highlights

In recent decades, benign prostatic hyperplasia (BPH) has become increasingly prevalent
Among symptoms other than lower urinary tract symptoms (LUTS) suggestive of BPH, patients often present with complaints of painful urination or discomfort in various nonspecific areas
Genitourinary pain can be manifested in several urological pathologies, such as bladder pain syndrome (BPS), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and overactive bladder (OAB)

Summary

Introduction

Benign prostatic hyperplasia (BPH) has become increasingly prevalent. Among symptoms other than lower urinary tract symptoms (LUTS) suggestive of BPH, patients often present with complaints of painful urination or discomfort in various nonspecific areas. Several reports have shown that approximately 7.7% to 40% of BPH patients suffer from bothersome genitourinary symptoms, such as discomfort or pain (GUDP), related to voiding [1,2,3]. Clinicians frequently encounter patients with BPH who complain of LUTS, and of pain or discomfort in the suprapubic/lower abdomen and the urethral, scrotal, perineal, or penile areas [2,4]. We often find that the nature of discomfort in these patients is usually bothersome and most commonly vague and nonspecific, making the pain difficult to classify as BPS, OAB, or CPPS [5,6]

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