Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: Results of a prospective trial

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

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). Methods 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. Results 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)428-432
Number of pages5
JournalUrology
Volume83
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Solid-State Lasers
Prostate
Urinary Bladder
Urodynamics
Urinary Retention
Urination
Patient Satisfaction
Catheterization
Catheters
Urine

ASJC Scopus subject areas

  • Urology

Cite this

Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility : Results of a prospective trial. / Mitchell, Christopher R.; Mynderse, Lance A.; Lightner, Deborah J.; Husmann, Douglas A.; Krambeck, Amy.

In: Urology, Vol. 83, No. 2, 02.2014, p. 428-432.

Research output: Contribution to journalArticle

Mitchell, Christopher R. ; Mynderse, Lance A. ; Lightner, Deborah J. ; Husmann, Douglas A. ; Krambeck, Amy. / Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility : Results of a prospective trial. In: Urology. 2014 ; Vol. 83, No. 2. pp. 428-432.
@article{d0ee900cb17549228ecd9408bcf25b31,
title = "Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: Results of a prospective trial",
abstract = "Objective To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). Methods 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. Results 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. Conclusion 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.",
author = "Mitchell, {Christopher R.} and Mynderse, {Lance A.} and Lightner, {Deborah J.} and Husmann, {Douglas A.} and Amy Krambeck",
year = "2014",
month = "2",
doi = "10.1016/j.urology.2013.09.035",
language = "English (US)",
volume = "83",
pages = "428--432",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility

T2 - Results of a prospective trial

AU - Mitchell, Christopher R.

AU - Mynderse, Lance A.

AU - Lightner, Deborah J.

AU - Husmann, Douglas A.

AU - Krambeck, Amy

PY - 2014/2

Y1 - 2014/2

N2 - Objective To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). Methods 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. Results 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. Conclusion 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.

AB - Objective To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). Methods 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. Results 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. Conclusion 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.

UR - http://www.scopus.com/inward/record.url?scp=84895070635&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84895070635&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2013.09.035

DO - 10.1016/j.urology.2013.09.035

M3 - Article

C2 - 24231217

AN - SCOPUS:84895070635

VL - 83

SP - 428

EP - 432

JO - Urology

JF - Urology

SN - 0090-4295

IS - 2

ER -