Preoperative anxiety has been shown to correlate with certain urinary symptoms in patients with certain types of voiding dysfunction, particularly overactive bladder. The purpose of this study was to evaluate if patient-reported anxiety correlates with pathologic characteristics, voiding symptoms, and objective metrics of bladder emptying in male patients undergoing holmium laser enucleation of the prostate (HoLEP).
We began collecting patient-reported anxiety scores (GAD-7) in addition to patient-reported scores of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) starting in November 2018 for men with LUTS due to benign prostate hyperplasia. We retrospectively evaluated the relationship between preoperative GAD-7 score with preoperative age, BMI, preoperative urine flow metrics, preoperative post-void residual (PVR), and preoperative symptom scores for LUTS (AUA, BII, and MISI) and ED (SHIM and MSHQ-EjD). We then compared preoperative GAD-7 score to enucleated prostate weight, post-operative GAD-7 scores, post-operative urine flow metrics, post-operative PVR, and postoperative symptom scores for LUTS and ED.
We included 139 patients for analysis. The preoperative GAD-7 score positively correlated with preoperative BII scores (rs=0.202, p=0.019), MISI total (rs=0.260, p=0.002) and MISI bother (rs=0.345, p<0.001) scores. Preoperative GAD-7 negatively correlated with preoperative MSHQ-EJD (rs=-0.191, p=0.031). Following HoLEP, all four of these correlations disappear. The GAD-7 score did not correlate with age, BMI, preoperative urine flow metrics, preoperative PVR, or other preoperative LUTS and ED symptom scores. Additionally, preoperative GAD-7 score showed no correlation with enucleated prostate weight, postoperative urine flow metrics, postoperative PVR, and postoperative LUTS and ED symptom scores.
Higher preoperative anxiety correlated with more severe pre-operative urinary LUTS, particularly incontinence symptoms, in patients undergoing HoLEP. Following HoLEP, these symptoms improve regardless of patient anxiety level.
Journal of endourology. 2020 May 12 [Epub ahead of print]
Charles Upshur Nottingham, Deepak Kumar Agarwal, Crystal Valadon, Tim Large, Marcelino E Rivera, Amy E Krambeck
Indiana University School of Medicine, Urology, 1701 North Senate Avenue, Indianapolis, Indiana, United States, 46202; ., Indiana University School of Medicine, Urology, Indianapolis, Indiana, United States; ., Indianapolis, United States; ., Indiana University Health Methodist Hospital, 22535, Department of Urology, Indianapolis, Indiana, United States; ., Indiana University Health Methodist Hospital, 22535, Indianapolis, Indiana, United States; ., Indiana University School of Medicine, 12250, Urology, 1801 Senate Blvd. #220, Indianapolis, Indiana, United States, 46202; .