BERKELEY, CA (UroToday.com) - Men with benign prostatic hyperplasia (BPH) and concomitant chronic urinary retention remain understudied despite making up a significant portion of the population undergoing surgical BPH therapy. Unfortunately, many men are not offered a de-obstructing procedure due to question of underlying impaired bladder contractility or postoperative uncertainty of discontinuing catheterization. These men are often relegated to clean intermittent catheterization or chronic indwelling catheters for bladder drainage, especially if bladder contractility is in question.
Photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP) are modern laser therapies for surgical treatment of BPH. Previously, we had prospectively studied the effect HoLEP had on patients with urodynamically-documented acontractile and underactive bladders.[1] In the current study, we extended our chronic urinary retention patient population to include all men with chronic urinary retention and BPH undergoing either PVP or HoLEP over a 3-year time period. In HoLEP, enucleation occurs by removing adenomatous tissue from the surrounding capsule, while PVP entails vaporization of prostatic tissue. Postoperatively, both groups experienced improved ability to void spontaneously to low postvoid residual volumes regardless of documented preoperative bladder contractility status. Importantly, 99% of those patients undergoing HoLEP were catheter-free at 6-months follow-up.
Overall, this study suggests that men treated with HoLEP for BPH and chronic urinary retention, regardless of bladder contractility, may expect to be able to void spontaneously postoperatively. We now counsel patients with chronic urinary retention and BPH that HoLEP may be confidently used in an attempt to rid them of the need for ongoing catheterization.
Reference:
- Mitchell CR, Mynderse LA, Lightner DJ, Husmann DA, Krambeck AE. Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: results of a prospective trial. Urology. 2014 Feb;83(2):428-32.
Written by:
Christopher D. Jaeger, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Mayo Clinic School of Medicine, Rochester, MN, USA