Presented by: Sai Vangala MD
Northern Ontario School of Medicine

Introduction

The objective of our study was to evaluate the efficacy and durability of GreenLight laser prostatectomy for the management of acute urinary retention (AUR) and chronic urinary retention (CUR) and to determine outcomes compared to patients without preoperative urinary retention.

Materials

We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy at our institution from May 2018 to July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained or median post-void residual urine volume (PVR) before catheterization or GreenLight laser prostatectomy. Chronic urinary retention (CUR) was defined as PVR >300 mL in males able to void and initial catheter drainage >1,000 mL in males unable to void, in the absence of pain. All patients had postoperative follow-up visits at 1, 3, 6, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status.

Results

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One hundred sixty-eight males who underwent GreenLight laser prostatectomy were included in our study. The urinary retention (UR) group consisted of 88 patients (50 AUR and 38 CUR), and the lower urinary tract symptoms (LUTS) group was comprised of 80 individuals. There were no statistically significant differences between the AUR and CUR subgroups regarding demographics. The CUR group had a significantly higher PVR at 1, 3, and 6 months than the AUR group. Other outcome measures were similar between the two groups. The UR group had a significantly higher age and duration of postoperative catheterization (p=0.000 and 0.000, respectively) than the LUTS cohort. During the 3 and 6-month follow-up visits, the UR group had a significantly higher PVR than the LUTS cohort. At 12 months follow-up, the LUTS group had a higher catheter-free rate than the UR group (p=0.008), and other outcome variables were comparable between the two cohorts. The successful first trial of void (TOV) rate for the UR and LUTS groups was 83% and 80%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 87.5% and 100%, respectively.

Conclusion

GreenLight laser prostatectomy is an effective and durable treatment for urinary retention with a high catheter-free rate and comparable outcomes when performed to manage LUTS.

Funding

None

Co-Authors

Parsa Nikoufar,
Northern Ontario School of Medicine

Amr Hodhod,
Northern Ontario School of Medicine

Moustafa Fathy,
Northern Ontario School of Medicine

Sai K Vangala,
Northern Ontario School of Medicine

Ahmed S Zakaria,
Northern Ontario School of Medicine

Ruba Abdul Hadi,
Northern Ontario School of Medicine

Vahid Mehrnoush,
Northern Ontario School of Medicine

Loay Abbas,
Northern Ontario School of Medicine

Waleed Shabana,
Northern Ontario School of Medicine

Owen Prowse,
Northern Ontario School of Medicine

Prashidhi Pathak,
Northern Ontario School of Medicine

Ahmed Kotb,
Northern Ontario School of Medicine

Walid Shahrour,
Northern Ontario School of Medicine

Hazem Elmansy,
Northern Ontario School of Medicine