The Impact of HoLEP on Nocturia in Patients with LUTS/BPH: A Prospective Study Involving Urodynamic Study Before and After HoLEP
Assistant Professor Yu Jin Kang (2), Professor Seung-June Oh (1)
(1) Department of Urology, Seoul National University, Seoul, South Korea, (2) Department of Urology, Dongguk Univeristy Gyeongjun Hospital, Gyeongju, Korea
Nocturia significantly impair quality of life in aged males. The causes of nocturia are largely known as nocturnal polyuria, detrusor overactivity and sleep disturbance. In most patients with BPH, nocturia persists even after prostatectomy. The purpose of this study was to investigate the change of nocturia after HoLEP in patients with LUTS/BPH and to find any related urodynamic factors associated with persistent nocturia.
A prospective study was performed between January 2010 and March 2012 in patients with LUTS/BPH aged over 50 years. Clinical investigations including baseline characteristics, IPSS, frequency-volume chart (FVC), serum PSA, uroflowmetry and PVR measurement, TRUS and urodynamic study were performed before HoLEP. Follow-up IPSS, FVC, serum PSA, uroflowmetry and PVR measurement and urodynamic study were repeated at postoperative 2 weeks, 3 months, and 6 months (Figure).
Out of a total of 95 patients, data from 71 patients (mean age of 68.5±6.7 years) were analyzed (excluding 20 patients taking anticholinergics, 1 patient taking desmopressin and 3 patients on behavioral therapy). The mean baseline total prostate volume was 72.4(±36.3) ml. There was a significant reduction of the number of nocturia in IPSS (preoperative 2.4±1.3 and postoperative 6 months 1.3±0.9) (p<0.001). FVC analysis showed that the number of nocturia (1.9±1.0 vs 0.9±0.7; p=0.026), maximum voided volume (366.3±131.7ml vs 456.6±247.9ml), average voided volume (214.1±84.0ml vs 249.0±85.0ml) and the nocturia index (1.7±0.8 vs 1.4±0.7; p=0.044) improved significantly at postoperative 6 months compared with those of baseline. However, there was no significant difference in nocturnal urine volume (585.7±249.4ml vs 596.0±319.0ml; p=0.23), nocturnal bladder capacity index (0.7±0.5 vs 0.7±0.6) (p=0.92), nocturnal polyuria index (0.4±0.1 vs 0.4±0.1; p=0.21), and sleep time (7.2±1.2hrs vs 7.2±1.3hrs; p=0.87). Urodynamic parameters also improved significantly at postoperative 6 months compared with those of baseline: first desire to void (189.6±94.2ml vs 206.8±75.9ml; p<0.001), strong desire to void (358.9±95.2ml vs 389.8±93.9ml; p<0.001), maximum cystometric capacity (377.5±126.8ml vs 412.7±120.7ml; p<0.001), and bladder outlet obstruction index (57.2±30.2 vs -2.3±15.8; p<0.001), except the rate of involuntary detrusor contraction (69.0% vs 74.6%; p=0.31). The decrease in the number of nocturia in the FVC was correlated with the increase in the maximum cystometric capacity (p=0.04), but was not correlated with the change in the maximum voided volume or average voided volume (p>0.05).
Our study demonstrated that nocturia parameters improved significantly after HoLEP surgery. The decrease in the number of nocturia after HoLEP was related with increase in the maximum cystometric capacity.