HoLEP effective for overactive bladder symptoms

Research shows that Holmium laser enucleation of the prostate (HoLEP) is effective in improving overactive bladder symptoms (OAB) and urodynamic parameters in men with benign prostatic hyperplasia (BPH).

The research team from South Korea, led by Seung-June Oh (Seoul National University Hospital), followed-up 165 men, aged an average of 68.4 years, who underwent the procedure over a 2-year period.

At 6 months after surgery, patients showed significant improvement in the International Prostate Symptom Score (IPSS), which fell from a mean of 20.7 before surgery to 5.5, as well as on the OAB questionnaire, with severity score dropping from a mean of 24.8 to 12.5. Frequency–volume chart recordings also showed significantly better results after HoLEP, with daytime frequency declining from a mean of 8.5 to 6.6, and nighttime frequency from 1.9 to 0.9.

The researchers also found that urodynamic parameters improved, with significant changes in urinary peak flow, postvoid urine volume, and bladder outlet obstruction index. The incidence of involuntary detrusor contraction (IDC) significantly decreased from 44.9% to 36.1% after surgery and the maximal cystometric capacity increased from a mean of 357.8 mL to 399.0 mL.

The team also notes that urinary incontinence was improved. There were 27 men with IDC and simultaneous urinary leakage preoperatively, but none at urodynamic testing 6 months postoperatively. And, 16 of the 19 men who required postoperative anticholinergics for urgency or urge urinary incontinence were able to discontinue therapy within 3 months.

Writing in Urology, Oh and colleagues explain that, to date, there have been few studies assessing the efficacy of HoLEP in OAB-related conditions and theirs is the first to objectively measure outcomes with urodynamic testing.

“These findings suggest that bladder dysfunction secondary to [bladder outlet obstruction] can be relieved by surgical deobstruction,” comment the authors.

“Further studies are needed to clarify whether these findings persist after longer periods of more than 6 months,” they add.

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