Presented by: T. Max Shelton MD
Indiana University School of Medicine

Introduction

Holmium laser enucleation of the prostate (HoLEP) is a size independent surgical option for patients with symptomatic prostatic enlargement. A significant proportion of patients experience lower urinary tract symptoms (LUTS) following outlet procedures. This study analyzed a retrospective cohort of HoLEP patients to determine risk factors for bladder botulinum toxin therapy (BTT) following HoLEP.

Materials

2482 patients underwent HoLEP at a single institution between 7/1/2019 and 10/1/2022. 13 patients underwent BTT following HoLEP. We randomly assigned 13 age-matched non-catheter-dependent post-HoLEP patients and compared outcomes.

Results

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Average prostate volume of the non-BTT group was 114.3 vs. 58.8 g in the BTT group (p= 0.02). Average enucleation times were 49.2 vs. 37.2 minutes for non-BTT and BTT patients (p=0.15). Energy per gram enucleated was 2.2 kJ/gram vs. 4.1 kJ/gram in non-BTT and BTT patients (p=0.04).  Significance was reached for higher preoperative tamsulosin (p=0.03) and lower anticholinergic usage (p=0.03) in non-BT patients. Mean time to BTT was 13.6 months following HoLEP. No differences were found in pre-operative PSA, presence of median lobe, diabetes mellitus, or neurological disorders. The average number of BTT treatments was 1.1 with mean time to treatment of 13.6 months. All BTT patients failed at least 1 non-invasive medical treatment prior to BTT.

Conclusion

Prostate size, enucleated volumes, and energy used per gram of tissue resected were notably different in BTT and non-BTT patients. Preoperative tamsulosin usage was significantly lower and anticholinergic usage was higher in BTT patients. Future studies are warranted to analyze risk factors for post-HoLEP LUTS.

Funding

None

Co-Authors

Precious Okoruwa,
Indiana University School of Medicine

Tyler Hesselbrock,
Indiana University School of Medicine

Mariah Thomas,
Indiana University School of Medicine

MInka Gill,
Indiana University School of Medicine

RJ Caras, DO
Indiana University School of Medicine

Austen Slade, MD
Indiana University School of Medicine

Marcelino Rivera, MD
Indiana University School of Medicine