Ho Louisa, Ramanujan Suruchi, Pramod Nikhil, Tang Stephen, Bena James F, De Smita
Cleveland Clinic Foundation, Glickman Urologic and Kidney Institute, Cleveland, OH.
Case Western Reserve University School of Medicine, Cleveland, OH.
Urology. 2024 Dec;194:231-237. doi: 10.1016/j.urology.2024.08.023. Epub 2024 Aug 22.
To compare post-operative outcomes in patients who underwent holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and had urodynamic evidence of bladder hypocontractility versus those with normocontractile bladders.
We retrospectively reviewed HoLEP patients with pre-operative urodynamic studies at a single institution, categorizing them into normocontractile and hypocontractile groups based on the bladder contractility index (BCI) (hypocontractile defined as BCI < 100). Post-void residual (PVR) volume was measured at 6 weeks and 6 months. Secondary outcomes included maximum flow rate (Qmax) and catheterization status.
Among 114 HoLEP patients with pre-operative urodynamic data, 49 had hypocontractile bladders. The median pre-operative PVR was 305 (202-446) mL in the hypocontractile group, higher than the median PVR of 190 (60-361) mL in the normocontractile group (P = .013). At 6 weeks post-op, the median PVR was higher in the hypocontractile compared to normocontractile group (38 [3-61] vs 5 [0-44] mL, P = .016), but at 6 months post-op there was no significant difference (18 [0-39] vs 12 (0-70) mL, P = .97). Among men who were catheter-dependent pre-operatively, 98% of hypocontractile and 100% of normocontractile patients were catheter-free post-operatively. Qmax and symptom scores were similar at both follow-up time points.
HoLEP can be an effective surgical option for BPH patients with hypocontractile bladders, including those who are catheter-dependent, with minimal differences in post-operative voiding parameters compared to those with normal bladder function.
比较因良性前列腺增生（BPH）接受钬激光前列腺剜除术（HoLEP）且有膀胱收缩功能减退的尿动力学证据的患者与膀胱收缩功能正常的患者的术后结局。
我们回顾性分析了在单一机构进行术前尿动力学研究的HoLEP患者，根据膀胱收缩指数（BCI）（收缩功能减退定义为BCI<100）将他们分为收缩功能正常组和收缩功能减退组。在术后6周和6个月测量残余尿量（PVR）。次要结局包括最大尿流率（Qmax）和导尿状态。
在114例有术前尿动力学数据的HoLEP患者中，49例膀胱收缩功能减退。收缩功能减退组术前PVR中位数为305（202 - 446）mL，高于收缩功能正常组的190（60 - 361）mL的PVR中位数（P = 0.013）。术后6周，收缩功能减退组的PVR中位数高于收缩功能正常组（38 [3 - 61] vs 5 [0 - 44] mL，P = 0.016），但术后6个月无显著差异（18 [0 - 39] vs 12 [0 - 70] mL，P = 0.97）。在术前依赖导尿的男性中，98%的收缩功能减退患者和100%的收缩功能正常患者术后无需导尿。在两个随访时间点，Qmax和症状评分相似。
HoLEP对于膀胱收缩功能减退的BPH患者，包括那些依赖导尿的患者，可能是一种有效的手术选择，与膀胱功能正常的患者相比，术后排尿参数差异最小。
