Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Non-neurogenic Impaired Bladder Contractility: Results of a Prospective Trial

Mitchell, Christopher; Mynderse, Lance A.; Lightner, Deborah J.; Husmann, Douglas A.; Krambeck, Amy E.

doi:10.1016/j.urology.2013.09.035

Cited by 55 publications

(30 citation statements)

References 17 publications

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“…Kwon et al reported that OAB symptoms and urodynamic parameters improved significantly after HoLEP surgery in short-term follow-up [8]. Additionally, Mitchell et al reported that HoLEP was highly efficacious in improving urinary symptoms in cases of impaired detrusor contractility [7]. However, only a small number of studies have compared the efficacy of surgical outcomes after HoLEP based on preoperative urodynamic findings.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, by using a holmium laser to perform complete enucleation of the prostate, Holmium Laser Enucleation of the prostate (HoLEP) has replaced TURP as the current standard operation, which has been shown to be an effective and safe surgical treatment for benign prostatic obstruction without any size limitation [6]. HoLEP offers excellent short‐term results for men with both hypocontractile and a contractile bladder [7], and overactive bladder symptoms and urodynamic parameters were also reported to improve significantly after HoLEP surgery in a short‐term follow‐up study [8]. However, studies on the efficacy of HoLEP in comparison to preoperative urodynamic findings are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non‐neurogenic bladder dysfunction

Pyun

Kang

et al. 2017

The Kaohsiung J of Med Scie

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We aimed to compare the short-term outcomes of men who had urodynamic evidence of detrusor underactivity (DU) or detrusor overactivity (DO) of a non-neurogenic etiology as well as bladder outlet obstruction (BOO) and who underwent Holmium Laser Enucleation of the prostate (HoLEP). A database of 322 patients who underwent HoLEP between 2010 and 2014 was analyzed. Patients were classified into three groups according to the results of a preoperative urodynamic study. Preoperative parameters such as International Prostate Symptom Score (IPSS), Quality of Life (QoL) index, IPSS grade, uroflowmetry were compared with postoperative parameters measured at 6 months. There were 138 patients with BOO-only and 89 patients with BOO and detrusor dysfunction including 56 with DO and 33 with DU. The degree of improvement in IPSS-total (BOO: 10.7, DO: 8.3, DU: 7.0; p = 0.023) was greater in the BOO-only group than in the DU group. There were more patients whose IPSS grade improved in the BOO-only group (71%) than in the detrusor dysfunction group (DO: 53.6% and DU: 45.5%). Postoperative IPSS-voiding (4.5 vs 7.0), and Qmax (18 vs 13.7) in the BOO-only group were significantly better than those in the DU group. Additionally, postoperative IPSS-storage (4.7 vs 6.7), and IPSS-total (9.1 vs 12.3) in the BOO-only group were significantly better than in the DO group (all p < 0.05). In conclusion, early surgical management for men with severe LUTS and associated BPH before secondary degeneration occurs may be beneficial for preserving detrusor function and yield better treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non‐neurogenic bladder dysfunction

Pyun

Kang

et al. 2017

The Kaohsiung J of Med Scie

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“…In a study of 19 men with nonneurogenic uncontractile bladders undergoing holmium laser enucleation of the prostate, P det significantly improved. 16 Contractions of the urethral sphincter stimulate the proprioceptive nerves in the bladder muscle, which then activate the inhibitory neural control of the bladder contraction. 17,18 The bladder neck and proximal urethra also play a role in the guarding reflex of the micturition cycle.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow up and predictive factors for successful outcome of transurethral incision of the bladder neck in women with detrusor underactivity

Jhang

Jiang

Lee

2016

Journal of the Formosan Medical Association

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“…However, one group theorized that substantial deobstruction with HoLEP may result in spontaneous urination, normal cycling of the bladder, rehabilitation of the detrusor muscle, and recovery of contractility. They studied 14 men with detrusor hypocontractility and 19 men with acontractility as demonstrated on urodynamics with evidence of bladder outlet obstruction from BPH 28. All of these men were catheter dependent.…”

Section: Resultsmentioning

confidence: 99%

Holmium laser enucleation of the prostate: patient selection and perspectives

Marien

Kadıhasanoğlu

Miller

2016

RRU

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BackgroundMultiple endoscopic surgical options exist to treat benign prostatic hyperplasia (BPH), including holmium laser enucleation of the prostate (HoLEP). HoLEP alleviates obstructive prostatic tissue via enucleation, both bluntly with a resectoscope and by cutting tissue with the holmium laser, and removal of adenoma via morcellation. This article reviews patient selection for HoLEP in order to optimize outcomes, costs, and patient satisfaction.MethodsA literature review of all studies on HoLEP was conducted. Studies that focused on outcomes in regard to patient and procedural factors were closely reviewed and discussed.ResultsVarious studies found that men with large or small prostates, on antithrombotic therapy, in urinary retention, with bladder hypocontractility, with prostate cancer, undergoing retreatment for BPH, or in need of concomitant surgery for bladder stones and other pathologies do well with HoLEP, as demonstrated by excellent functional and symptomatic outcomes as well as low complication rates. There is a 74–78% rate of retrograde ejaculation following HoLEP. Techniques to preserve ejaculatory function following enucleative techniques have not been able to demonstrate a significant improvement.ConclusionPatient selection for HoLEP can include most men with bothersome BPH who have evidence of bladder outlet obstruction and are healthy enough to undergo surgery. The ability to safely perform concomitant surgery with HoLEP benefits the patient by sparing them an additional anesthetic and also decreases costs. Patients should be made aware of the risk of retrograde ejaculation following HoLEP and counseled on treatment alternatives if maintaining ejaculatory function is desired.

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Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Non-neurogenic Impaired Bladder Contractility: Results of a Prospective Trial

Cited by 55 publications

References 17 publications

Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non‐neurogenic bladder dysfunction

Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non‐neurogenic bladder dysfunction

Long-term follow up and predictive factors for successful outcome of transurethral incision of the bladder neck in women with detrusor underactivity

Holmium laser enucleation of the prostate: patient selection and perspectives

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