Efficacy of Holmium laser enucleation of the prostate in men with impaired bladder contractility: A review

Abstract

Introduction:

Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO.

Methods:

We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention.

Results:

Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO.

Conclusion:

The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis.

Level of evidence:

Not applicable.

Keywords

Benign prostate disorders urodynamics hyperplasia HoLEP Holmium laser

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References

Mirone

Imbimbo

Longo

, et al. The detrusor muscle: An innocent victim of bladder outlet obstruction. Eur Urol 2007; 51(1): 57–66.

Griffiths

Hofner

van Mastrigt

, et al. Standardization of terminology of lower urinary tract function: Pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn 1997; 16(1): 1–18.

Abrams

. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: Three simple indices to define bladder voiding function. BJU Int 1999; 84(1): 14–15.

Tanaka

Masumori

Itoh

, et al. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol 2006; 13(11): 1398–1404.

Thomas

Cannon

Bartlett

, et al. The natural history of lower urinary tract dysfunction in men: The influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int 2004; 93(6): 745–750.

Cho

Park

, et al. Impact of detrusor underactivity on surgical outcomes of laser prostatectomy: Comparison in serial 12-month follow-up outcomes between potassium-titanyl-phosphate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). Urology 2016; 91: 158–166.

Montorsi

Naspro

Salonia

, et al. Holmium laser enucleation versus transurethral resection of the prostate: Results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2004; 172(5Pt1): 1926–1929.

Mitchell

Mynderse

Lightner

, et al. Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: Results of a prospective trial. Urology 2014; 83(2): 428–432.

Ryoo

Suh

Kim

, et al. Efficacy of holmium laser enucleation of the prostate based on patient preoperative characteristics. Int Neurourol J 2015; 19(4): 278–285.

10.

Jaeger

Mitchell

Mynderse

, et al. Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention. BJU Int 2015; 115(2): 295–299.

11.

Lomas

Krambeck

. Long-term efficacy of holmium laser enucleation of the prostate in patients with detrusor underactivity or acontractility. Urology 2016; 97: 208–211.

12.

Pyun

Kang

, et al. Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non-neurogenic bladder dysfunction. Kaohsiung J Med Sci 2017; 33(9): 458–463.

13.

Woo

Lee

, et al. Comparison of surgical outcomes between holmium laser enucleation and transurethral resection of the prostate in patients with detrusor underactivity. Int Neurourol J 2017; 21(1): 46–52.

14.

Ahn

Park

Sun

, et al. Can preopeative detrusor underactivity have an impact on surgical outcomes of laser prostatectomy: Comparison in serial 3-year follow-up outcomes between 120-W lithium triborate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). Eur Urol Suppl 2017; 16: e505–e506.

15.

Cho

Yoo

Park

, et al. Effect of preoperative detrusor underactivity on long-term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: A lesson from 5-year serial follow-up data. BJU Int 2019; 123(5A): E34–E42.

16.

Cho

Park

Kim

, et al. Can preoperative detrusor underactivity influence surgical outcomes of 120 W HPS vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP)? A serial 3-year follow-up study. Neurourol Urodyn 2018; 37(1): 407–416.

17.

Abrams

Cardozo

Fall

, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61(1): 37–49.

18.

Rollema

Van Mastrigt

. Improved indication and followup in transurethral resection of the prostate using the computer program CLIM: A prospective study. J Urol 1992; 148(1): 111–115; discussion 115–116.

19.

Taylor

3rd Kuchel

. Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc 2006; 54(12): 1920–1932.

20.

Pan

Chen

, et al. Urodynamically diagnosed detrusor hypocontractility: Should transurethral resection of the prostate be contraindicated? Int Urol Nephrol 2012; 44(1): 35–39.

21.

Han

Jeong

Choo

, et al. The efficacy of transurethral resection of the prostate in the patients with weak bladder contractility index. Urology 2008; 71(4): 657–661.

22.

Tan

Liao

, et al. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg 2007; 94(10): 1201–1208.

23.

Elzayat

Habib

Elhilali

. Holmium laser enucleation of the prostate: A size-independent new ‘gold standard’. Urology 2005; 66(Suppl. 5): 108–113.