BOOI-Defined Obstruction Stratifies Early Outcomes After ThuLEP in Men With Detrusor Underactivity: A Retrospective...

Area of Science:

• Urology
• Surgical Innovation
• Lower Urinary Tract Symptoms

Background:

• The efficacy of transurethral surgery for benign prostatic enlargement/obstruction (BPE/BPO) with detrusor underactivity (DU) is uncertain, especially without confirmed bladder outlet obstruction (BOO).
• Pressure-flow testing is crucial for diagnosing BOO, but its role in predicting surgical outcomes in men with DU and BPE/BPO requires further investigation.

Purpose of the Study:

• To assess early outcomes of transurethral thulium laser enucleation of the prostate (ThuLEP) in men experiencing voiding dysfunction due to DU and BPE/BPO.
• To determine if bladder outlet obstruction index (BOOI)-defined obstruction status influences early postoperative improvement following ThuLEP.

Main Methods:

• Retrospective analysis of 189 ThuLEP records, focusing on a 100-patient cohort with preoperative pressure-flow studies and 3-month follow-up.
• Patients were categorized by DU (bladder contractility index < 100) and BOO status (definite, equivocal, or no BOO via BOOI).
• Functional, symptom, catheter removal, anatomical, and safety outcomes were compared across BOO strata.

Main Results:

• Ninety-one percent of patients had DU. Significant improvements in maximum flow rate (Qmax) and reduced post-void residual (PVR) volume were observed post-ThuLEP (p < 0.001).
• International Prostate Symptom Score (IPSS) and quality of life (QoL) scores also improved.
• Catheter removal success rates varied by BOO status: 83.9% (definite BOO), 68.0% (equivocal BOO), and 40.0% (no BOO).

Conclusions:

• Preoperative BOOI-based stratification can aid in counseling men with DU regarding expected functional improvements after ThuLEP.
• The study suggests that BOOI-defined obstruction status may stratify early outcomes, although findings are exploratory due to retrospective design and small subgroups.