Predisposing factors of persistent storage symptoms after holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia and their correlations to the symptom recovery period

Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms (LUTS) in older men. Although medical treatments can reduce BPH-related LUTS and even prevent invasive treatments, at least one in five men who complain of LUTS due to BPH will eventually need surgery. Of LUTS, storage symptoms persist in 20 to 40% of patients even after the obstruction is resolved. The present study aims to investigate the predisposing factors of the persistent storage symptoms after HoLEP in patients with BPH and their correlations to the recovery time of the symptoms. A total of 127 patients with complaints of storage symptoms and who underwent transurethral HoLEP surgery at Pusan National University Hospital from May 2014 to June 2017 were included in this study. Urodynamic studies were performed in all patients, and BOO was confirmed by urodynamic studies before HoLEP. All patients were asked to complete the IPSS (also known as the American Urological Association score) and the Overactive Bladder Symptom Score (OABSS) questionnaire to evaluate LUTS on the day before HoLEP and 3 months after HoLEP. Patients were divided into group I, which included patients with persistent storage symptoms after HoLEP, and group II, which included patients without storage symptoms after HoLEP. Of a total of 127 patients, 68 were included in group I, and the remaining 59 were included in group II. In the univariable analysis, group I showed statistically significantly older mean age, higher mean peak detrusor pressure during filling cystometry, and lower mean MCC than group II. Multivariate analysis of these three variables showed that only mean age and mean peak detrusor pressure during filling cystometry had statistically significant differences. In group I, 12 patients had storage symptoms until 12 months after surgery. When comparing these patients with the remaining 56 patients, only mean age showed statistically significant differences. Old age and high peak detrusor pressure during filling cystometry were the predictors of persistent storage symptoms after HoLEP. Furthermore, older patients were unlikely to recover storage symptoms until 12 months after operation.