Clinical Outcomes of Holmium Laser Enucleation of the Prostate in Patients With Diminished Bladder Contractility

Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is common in aging men and can be treated with holmium laser enucleation of the prostate (HoLEP). However, diminished bladder contractility (DC) is also highly prevalent (9%-48%) and can be clinically indistinguishable from BOO without urodynamics (UDS). While HoLEP effectively treats BPH/BOO, clinical outcomes data for patients with DC are limited and mixed. We aim to compare the prevalence and risk factors of catheter dependence among patients with and without DC after HoLEP.

A retrospective cohort study was conducted on 179 patients with preoperative UDS who underwent HoLEP between June 2018 and December 2023. Diminished contractility was defined as Bladder Contractility Index (BCI) < 100. Statistical analyses included univariate and multivariate logistic regression.

Among 179 patients, 103 (57.5%) had DC (BCI < 100). After HoLEP, all patients with normal contractility (NC) were voiding while 7.8% of patients with DC were catheter dependent (P = .01) at a mean follow-up of 28 months. Preoperative BCI was associated with post-HoLEP catheter dependence (OR = 0.97, 95% CI 0.95-1.00, P = .046). Postoperative International Prostate Symptom Scores were significantly higher in DC compared with NC groups despite similar preoperative scores.

HoLEP rendered 95.5% (171/179) of patients catheter free. However, patients with DC were more likely to require catheterization postoperatively and reported worse urinary symptoms compared with patients with NC. Our results support obtaining UDS when there is clinical concern for DC because this may guide shared decision-making before pursuing HoLEP.