Abstracts: Prediction of urge urinary incontinence (UUI) after holmium laser enucleation of prostate (HoLEP): revisiting the urodynamic detrusor overactivity (DO)

Prediction of urge urinary incontinence (UUI) after holmium laser enucleation of prostate (HoLEP): revisiting the urodynamic detrusor overactivity (DO)

Introduction

Recent recommendation of international continence society (ICS, 2002) suggested the qualification of urodynamic DO as according to their pattern (phasic or terminal) or causes (neurogenic or idiopathic). However, quantification of DO has not been suggested. It is well known that there are some discordances between urodynamic DO and actual storage symptoms such as UUI. We assessed whether the quantification of urodynamic DO can improve the prediction of post-operative UUI following the HoLEP in patients with benign prostatic hyperplasia.

Methods

We prospectively measured the filling volume at DO (Vol_DO), detrusor pressure at DO (P_detDO), and presence or absence of DO incontinence, in addition to the ICS recommendations for urodynamic study (UDS) in 105 patients who underwent HoLEP between May 2010 and September 2015.

Results

Mean age (±SD) and prostate volume were 71.1 (±7.0) years and 63.7 (±24.2) mL. Of the 105 patients, 10 (9.5%) patients experienced the UUI at post-operative 3 months. The UUI-positive group demonstrated higher international prostate symptom score (IPSS)-storage (11.4 vs. 7.5, p=0.004) than the UUI-negative group. However, other parameters such as age, prostate size, preoperative uroflometry findings, IPSS-emptying, and IPSS-QoL were not significantly different between two groups (p range, 0.062-0.797). On UDS findings, UUI-positive group showed higher P_detDO than UUI-negative group (100.4 vs. 54.7 cmH₂O, p=0.008). However, rates of DO presence and DO_vol were not significantly different between two groups (p-value, 0.423 and 0.788). DO incontinence is more frequent in UUI-positive group than in UUI-negative group, but failed to reach the statistical significance (80.0 vs. 52.6%, p=0.098). Spline curve analysis results suggested the optimal cut-off value of P_detDO for increased risk of UUI as 108.0 cmH₂O (Figure). Our multivariate analysis revealed that pre-operative IPSS-storage (OR=1.696, p=0.036) and P_detDO (≥108.0 cmH2O; OR=15.546, p=0.044) were independent predictive factors for UUI after HoLEP.

Conclusions

Quantification of urodynamic DO improved the prediction of UUI after HoLEP

Funding

None

Authors

Myong Kim
Tai Young Ahn
Myung-Soo Choo