Risk Factors for Persistent Storage Symptoms after Holmium Laser Enucleation of Prostate

ABSTRACT

OBJECTIVE: Holmium laser enucleation of prostate (HoLEP) is as fast-paced treatment that is one of the standard treatment for benign prostate hypoplasia. However, there is a rare case that the satisfaction rate of surgery is lowered due to storage symptoms such as frequency and urgency. We investigated the risk factors of bladder irritation symptoms persisted after holmium laser enucleation of prostate. METHODS: From January 2009 to December 2014, 220 patients underwent HoLEP in Soonchunhyang University Cheonan Hospital. Among them, 133 patients were selected who did not have any problem that could affect the voiding function including urologic cancer, neurogenic bladder, urinary tract infection, and bladder stone disease. At 3 months after surgery patients were divided into two groups postoperative International Prostate Symptom Score (IPSS) storage symptom scores <8 (group I) and ≥8 (group II). The two groups were analyzed the parameters preoperative (prostate size, uroflowmetry, IPSS, prostate calcification), intraoperative (operative time, resected prostate weight), and postoperative (IPSS, uroflowmetry). RESULTS: Of the 133 patients, 94 patients were assigned to group I and 39 patients were group II. Age of the patients, the prostate size, and maximal urinary flow rate showed no statistical difference in both groups. Preoperative storage symptom scores were significantly higher in group II (P<0.05) and IPSS voiding-to-storage subscore ratio was lower in group II without significance (P<0.05). The prostate calcification, periurethral prostatic calcification, and intravesical prostatic protrusion was no difference in the two groups. Postoperative IPSS, maximal urinary flow rate, and post-void residual urine volume was improved in two groups but storage symptom score was not improved in group II. Operative time and resected prostate weight were not found the differences, and postoperative parameters (maximal urinary flow rate, post-void residual urine volume) were showed no difference in both groups. However all of the IPSS was higher in group II. CONCLUSION: Many symptom improvements after HoLEP were observed but some patients may have difficulties due to persistent bladder irritation. Because bladder irritation sign could persist after surgery if preoperative storage symptom score was higher, it is necessary for a detailed description before surgery.