Abstract: PD39-02
Sources of Funding: None.

Introduction

Detrusor underactivity is a common clinical problem associated with various lower urinary tract symptoms (LUTS). Impaired bladder contractility can affect the outcome of transurethral prostatectomy. The aim of this study is to evaluate the impact of bladder contractility on outcomes of Holmium laser enucleation of the prostate (HoLEP) in objective and subjective parameters.

Methods

From December 2009 to December 2015, 797 patients with LUTS/BPH were prospectively enrolled in the Seoul National University Benign Prostatic Hyperplasia Database Registry, and underwent HoLEP by a single surgeon. Preoperative evaluation included International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), urgency perception scale (UPS), PSA, postvoid residual volume (PVR) and urodynamic study. At postoperative 6 months, IPSS, OABSS, uroflowmetry, PSA and self-administered questionnaires regarding satisfaction to treatment questions (STQ), overall response assessment (ORA) and willingness to undergo the surgery again question (WUSAQ) were obtained. Bladder contractility was classified as weak, normal and strong according to the bladder contractility index (BCI) of <100, 100-150 and >150. Detrusor underactivity (DUA) was defined as BCI<100. Subjective and objective parameters were compared according to the degree of contractility.

Results

Among 768 patients, 351 (45.7%) had DUA and 63 (7.9%) had strong contractility. Mean age, preoperative IPSS, QoL, Qmax and prostate volume were 69.3 years, 19.2, 4.2, 9.2mL/sec and 70.8mL, respectively. Patients having stronger bladder contractility tended to be younger, have larger prostate volume, higher preoperative OABSS, UPS, bladder outlet obstruction index and larger PVR with significant tendency according to the contractility. However, preoperative Qmax and IPSS were not different among 3 groups. At postoperative 6 months, Qmax, IPSS voiding and QoL were significantly improved as the degree of contractility increases, whereas OABSS, PVR and UPS were not different among 3 groups. Overall, 93.9% of patients were satisfied after the surgery and 99.0%, 94.2% of patients reported improvements and willingness in ORA and WUSAQ, respectively. Patient satisfaction were not different by the degree of contractility. Multiple logistic regression analysis showed that the history of neurologic disease (OR 0.23; 95% CI 0.10-0.50, p<0.001) was the only risk factor for decreased satisfaction.

Conclusions

Patients having DUA tended to have less improvement in voiding symptoms postoperatively than those without DUA. However, patient satisfaction were not affected by the degree of bladder contractility.

Funding

None.