Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Non-neurogenic Impaired Bladder Contractility: Results of a Prospective Trial
To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). A prospective case series between 2009 and 2012 was performed to examine short-term outcomes of men with urodynamic evidence of detrusor hypocontractility or acontractility because of a non-neurogenic etiology and concurrent benign prostatic obstruction (BPO), undergoing HoLEP. Fourteen patients with detrusor hypocontractility and 19 patients with acontractility and evidence of BPO underwent HoLEP during the study period. Median age was 71.5 and 75 years, respectively. Preoperatively, 5 (35.7%) men with hypocontractility and 19 (100%) men with acontractility had catheter-dependent urinary retention for a median of 3 and 9 months, respectively. At a median follow-up of 24.7 months, all 5 (100%) men with hypocontractility and 18 of 19 (94.7%) men with acontractility were voiding spontaneously without the need for intermittent catheterization. Individuals with hypocontratile bladders had statistically significant improvements in American Urological Association Symptom Index (21.5 vs 3; P = .014), maximum urine flow (Qmax, 10 vs 21 mL/s; P = .001), and postvoid residual (250 vs 53 mL; P = .007) from baseline to postoperative assessments. In patients with an acontractile bladder, 15 of 19 (78.9%) displayed significant return of detrusor contractility, whereas 4 of 19 (21.1%) were voiding exclusively by Valsalva effort on follow-up urodynamic study. Postoperatively, patient satisfaction, as ascertained by American Urological Association Symptom Index, was high for both groups. Intermediate follow-up results indicate that HoLEP is a viable management option for men with BPO and detrusor hypocontractility. Furthermore, detrusor acontractility does not appear to adversely affect postoperative results, with return of spontaneous urination and demonstration of detrusor contractility allowing for efficient voiding, in over 95% of patients.