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Super early detailed assessment of lower urinary tract symptoms after holmium laser enucleation of the prostate (HoLEP): a prospective study

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Abstract

Purpose

To prospectively investigate early and consecutive changes of lower urinary tract symptoms (LUTS), specifically storage symptoms after holmium laser enucleation of the prostate (HoLEP).

Methods

Patients referred for HoLEP completed the International Prostatic Symptom Score (IPSS) the day before, at discharge, and 1, 2, 3, 4, 6, 8, 12, 16, 20, 24, and 52 weeks after HoLEP. Total IPSS was stratified into mild (score 0–7), moderate (8–19), and severe (20–35) LUTS. Storage symptoms were sub-stratified into storage “negative” and “positive”. IPSS changes served as the main postoperative outcome. Mixed linear models identified risk factors affecting postoperative recovery of LUTS.

Results

Between December 2010 and 2012, 144 consecutive HoLEP patients were prospectively included in the study. Preoperatively 57.6% of the cohort reported severe storage symptoms (mean total IPSS: 22.6 ± 5.0). Total IPSS decreased significantly immediately after surgery (p < 0.001). Patients with severe LUTS, storage-positive sub-score, and high maximum urinary flow rate were affected by a rebound of mainly storage symptoms 6–8 weeks after HoLEP and prolonged recovery from LUTS. Of these, about 7.4% presented persisting urge complaints. Finally, 12 weeks following HoLEP, the vast majority of patients were symptom-free. Limitations of this study include missing urodynamic workup and a comparative patient cohort.

Conclusion

Immediately after HoLEP, patients experience a significant decrease of LUTS. Continuous symptom recovery seems to be hampered in patients with severe and storage-positive baseline symptoms. (De-novo) storage symptoms slightly affect postoperative recovery. Quality of life is restored to a stable and significantly improved status 3 months after surgery.

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Funding

The authors declare that there is no funding.

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Author notes

  1. Sascha A. Ahyai and Irina Marik have equally contributed first.

Authors and Affiliations

  1. Department of Urology, University Medical Center Goettingen, Robert-Koch-St. 40, 37075, Goettingen, Germany

    Sascha A. Ahyai, Saman Asdjodi & Marianne Schmid

  2. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Irina Marik, Tim A. Ludwig & Margit Fisch

  3. Department of Urology, University Medical Center Frankfurt a.M., Frankfurt a. M, Germany

    Andreas Becker, Luis Kluth & Felix Chun

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  1. Sascha A. Ahyai
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Contributions

All authors whose names appear on the submission have contributed sufficiently to the scientific work and, therefore, share collective responsibility and accountability for the results: SA: project development, data collection and management, data analysis, and manuscript editing; IM: data collection and management, data analysis, and manuscript writing; TAL: data management and manuscript editing; AB: data management and manuscript editing; SA: manuscript writing and editing; LA: data management and manuscript editing; FC: project development, data management, and manuscript editing; MF: project development and manuscript editing; MS: data analysis, manuscript writing, and editing;

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Correspondence to Sascha A. Ahyai.

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Our study was approved by the local ethics committee and performed in accordance with the ethical standards of the institutional research committee. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Ahyai, S.A., Marik, I., Ludwig, T.A. et al. Super early detailed assessment of lower urinary tract symptoms after holmium laser enucleation of the prostate (HoLEP): a prospective study. World J Urol 38, 3207–3217 (2020). https://doi.org/10.1007/s00345-020-03126-x

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