Abstract
In order to investigate how holmium laser enucleation of the prostate (HoLEP) improves urinary storage symptoms, we assessed blood flow in the urinary bladder mucosa of patients with benign prostatic hyperplasia (BPH) before and after laser surgery. Seventy-four consecutive patients with BPH (median age 69 years, range; 53–88) underwent HoLEP at our institution and are included in this study. We prospectively assessed the International Prostate Symptom Score (IPSS), IPSS-QOL Score, the Overactive Bladder Symptom Score (OABSS), uroflowmetry, and blood flow in the urinary bladder, before and after surgery. Blood flow in the bladder mucosa was measured using the OMEGA FLOW (OMEGAWAVE, Tokyo, Japan) laser Doppler flowmeter. The median volume of the enucleated adenomas was 45.0 g (range: 25.0 to 83.2). The median IPSS improved significantly from 20 (range: 6–35) to 3 (0–22) (p<0.001; Wilcoxon signed-rank test), as did the storage symptoms score, which decreased from 13 (2–20) to 3 (1–8) (p<0.001). Median bladder blood flow increased at the trigone from 9.57±0.83 ml/sec to 17.60±1.08 ml/sec. Multiple regression analysis for the improved storage symptom score eliminated all explanatory variables except increased bladder perfusion. The data suggest that HoLEP improves blood flow in the bladder mucosa, which independently leads to the improvement of storage symptoms.
Highlights
Holmium laser enucleation of the prostate (HoLEP) has become a gold standard treatment for prostate enlargement.[1]
The expanding adenoma in benign prostatic hyperplasia (BPH) creates a natural tissue plane that can be exploited by HoLEP without destroying the bladder neck
In addition to relief of voiding symptoms, our findings show that HoLEP significantly reduced the severity of storage symptoms in patients undergoing this procedure
Summary
Holmium laser enucleation of the prostate (HoLEP) has become a gold standard treatment for prostate enlargement.[1]. HoLEP enables the immediate relief of bladder outlet obstruction and produces an excellent outcome in terms of feasibility, safety, and efficacy.[1, 2] Storage symptoms are currently. Bladder Blood Flow after HoLEP largely encompassed by the term "overactive bladder syndrome" or OABS. The symptoms produced by OAB are believed to correlate with underlying overactivity of the detrusor muscle.[3] Women with OAB experience identical symptoms to men, but the symptoms originate primarily from the bladder.[4] In men, older men with BPH, symptoms of OAB arise from secondary causes, including prostatic pathology. Several reports have shown relief of OAB symptoms in men following surgery for BPH.[5, 6]
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