Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Detrusor Underactivity or Acontractile Bladder.

Purpose: This study evaluates the efficacy of holmium laser enucleation of the prostate (HoLEP) as a deobstructive surgical intervention for patients with detrusor underactivity (DU) or an acontractile bladder (AcB).

Methods: Between April 2021 and May 2024, patients undergoing HoLEP for benign prostatic obstruction (BPO) were selected based on urodynamic study results indicating DU or AcB. The primary outcome was the change in voiding efficiency (VE) following HoLEP. Secondary outcomes included differences in VE between subgroups, such as the DU and AcB groups. The VE trend over time was visualized using Python's Seaborn library with the locally weighted scatterplot smoothing method, and plots were generated using Matplotlib.

Results: Fourteen patients with DU and 12 patients with AcB underwent HoLEP during the study period. In the DU group, the median age was 76.5 years, with a prostate size of 48.6 mL and 39% of tissue resected. In contrast, the AcB group had a median age of 74.5 years, a prostate size of 68 mL, and 44.5% of tissue resected. The median duration from symptom onset to surgery was 4.3 years in the DU group and 0.8 years in the AcB group. The median preoperative VE was 0% (n=26), which significantly increased to 81.3% postoperatively (P=0.0). VE increased sharply up to one month postoperatively, then plateaued. Additionally, other voiding functions showed statistically significant improvements in maximum urine flow (0 mL/sec vs. 14.4 mL/sec, P=0.0) and postvoid residual (325 mL vs. 45 mL, P=0.0). No significant difference in VE was found between the DU and AcB groups.

Conclusion: HoLEP effectively improves VE and symptoms as a deobstructive surgical intervention for patients with BPO and DU or AcB. There was no significant difference in outcomes between patients with DU and AcB.