Presented by: Smita De MD, PhD
Cleveland Clinic

Introduction

Holmium Laser Enucleation of the Prostate (HoLEP) has become a popular surgical treatment for benign prostatic hyperplasia (BPH) given that it is size-independent and is associated with shorter hospital stays and less blood loss compared to traditional techniques. We evaluated outcomes of patients with hypocontractile bladders and BPH who underwent HoLEP as counseling these patients can be challenging. Our objective was to compare 6-week and 6-month post-HoLEP outcomes in patients with hypocontractile bladders to those with normocontractile bladders.

Materials

We conducted a retrospective review of all HoLEP patients who had preoperative urodynamics at a single institution between December 2019 and June 2022. Bladder contractility index (BCI) was used to categorize patients into two groups: normocontractile and hypocontractile (BCI < 100 or inability to urinate). Post-void residual (PVR) was assessed as the primary outcome at 6 weeks and 6 months. Secondary outcomes include catheterization status, AUASS, and urinary quality of life.

Results

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Of 92 HoLEP patients with complete urodynamic evaluation, 44 had hypocontractile bladders. In the hypocontractile group, the mean PVR at 6 weeks post-op was 57.05 mL versus 35 mL in the normocontractile group (p = 0.36). At 6 months post-op, the mean PVR in the hypocontractile group was 27.6 mL versus 42 mL in the normocontractile group (p = 0.57) (Figure 1). 95.5% (21/22) of patients who were catheter-dependent pre-op in the hypocontractile group were catheter-free following surgery compared to all (13/13) who were catheter-dependent in the normocontractile group. At 6 weeks post-op, there was no significant difference between mean AUASS (p = 0.75) and urinary quality of life (p = 0.74) in the hypocontractile and normocontractile groups. At 6 months post-op, there was no significant difference between mean AUASS (p = 0.44) and urinary quality of life (p = 0.85) between the two groups.

Conclusion

HoLEP is an effective surgical option in BPH patients with hypocontractile bladders, including those who are catheter dependent. Similar results were seen 6 weeks and 6 months postoperatively in patients with hypocontractile and normocontractile bladders.

Funding

None

Lead Authors

Suruchi Ramanujan, AB
Case Western Reserve University School of Medicine

Co-Authors

Nikhil Pramod, BS
Cleveland Clinic Lerner College of Medicine

William Jevnikar, BS
Wright State University Boonshoft School of Medicine