Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
BJU Int. 2024 Jun;133(6):770-777. doi: 10.1111/bju.16346. Epub 2024 Mar 22.
To evaluate the effect of detrusor underactivity (DUA) on the postoperative outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH).
Patients with BPH who underwent HoLEP between January 2018 and December 2022 were enrolled in this prospective database study. Patients were divided into DUA (bladder contractility index [BCI] <100) and non-DUA (BCI ≥100) groups. Objective (maximum urinary flow rate [Q], post-void residual urine volume [PVR]) and subjective outcomes (International Prostate Symptom Score [IPSS], Overactive Bladder Symptom Score [OABSS], satisfaction with treatment question [STQ], overall response assessment [ORA], and willingness to undergo surgery question [WUSQ]) were compared between the two groups before surgery, and at 3 and 6 months after HoLEP.
A total of 689 patients, with a mean (standard deviation [SD]) age of 69.8 (7.1) years, were enrolled. The mean (SD) BCI in the non-DUA (325 [47.2%]) and DUA (364 [52.8%]) groups was 123.4 (21.4) and 78.6 (14.2), respectively. Both objective (Q and PVR) and subjective (IPSS, IPSS-quality of life, and OABSS) outcomes after surgery significantly improved in both groups. The Q was lower in the DUA than in the non-DUA group postoperatively. At 6 months postoperatively, the total IPSS was higher in the DUA than in the non-DUA group. There were no significant differences in surgical complications between the two groups. Responses to the STQ, ORA, and WUSQ at 6 months postoperatively demonstrated that the patients were satisfied with the surgery (90.5% in the DUA group; 95.2% in the non-DUA group), their symptoms improved with surgery (95.9% in the DUA group; 100.0% in the non-DUA group), and they were willing to undergo surgery again (95.9% in the DUA group; 97.9% in the non-DUA group). There were no significant differences in the responses to the STQ and WUSQ between the two groups.
Our midterm results demonstrated that patients with BPH and DUA showed minimal differences in clinical outcomes after HoLEP compared to those without DUA. The overall satisfaction was high in the DUA group.
评估逼尿肌无力（DUA）对良性前列腺增生（BPH）患者行钬激光前列腺剜除术（HoLEP）术后结局的影响。
本前瞻性数据库研究纳入了 2018 年 1 月至 2022 年 12 月期间接受 HoLEP 的 BPH 患者。患者被分为 DUA（膀胱收缩力指数[BCI]＜100）和非 DUA（BCI≥100）组。比较两组患者术前、术后 3 个月和 6 个月的客观（最大尿流率[Q]、残余尿量[PVR]）和主观结局（国际前列腺症状评分[IPSS]、膀胱过度活动症症状评分[OABSS]、治疗满意度问题[STQ]、整体反应评估[ORA]和再次手术意愿问题[WUSQ]）。
共纳入 689 例患者，平均（标准差[SD]）年龄为 69.8（7.1）岁。非 DUA（325[47.2%]）和 DUA（364[52.8%]）组的平均（SD）BCI 分别为 123.4（21.4）和 78.6（14.2）。两组患者术后的客观（Q 和 PVR）和主观（IPSS、IPSS 生活质量和 OABSS）结局均显著改善。术后 DUA 组的 Q 值低于非 DUA 组。术后 6 个月时，DUA 组的总 IPSS 高于非 DUA 组。两组间手术并发症无显著差异。术后 6 个月时的 STQ、ORA 和 WUSQ 反应表明，患者对手术满意（DUA 组 90.5%；非 DUA 组 95.2%），手术改善了他们的症状（DUA 组 95.9%；非 DUA 组 100.0%），他们愿意再次接受手术（DUA 组 95.9%；非 DUA 组 97.9%）。两组间 STQ 和 WUSQ 的反应无显著差异。
我们的中期结果表明，与无 DUA 的患者相比，BPH 合并 DUA 的患者行 HoLEP 后的临床结局差异较小。DUA 组的总体满意度较高。
