Intraoperative factors associated with de novo overactive bladder after Holmium Laser enucleation of the prostate

HoLEP markedly attenuates symptoms in the majority of patients with BPH. However, a subset develops de novo OAB postoperatively, which may significantly compromise QOL. Despite its clinical relevance, evidence regarding the incidence of and perioperative factors contributing to de novo OAB after HoLEP remains limited.

The present study included 536 patients who underwent HoLEP between April 2013 and September 2023. Among them, 175 patients without preoperative OAB were eligible for analysis.

De novo OAB was identified in 18 of 175 patients (10.3%). Baseline demographic and preoperative characteristics did not significantly differ between the groups. Intraoperatively, patients who developed de novo OAB exhibited shorter enucleation times, whereas the durations of other intraoperative procedures were significantly longer. Postoperatively, IPSS-QOL scores were significantly higher in the de novo OAB group, indicating impaired satisfaction, while voiding function parameters were similar between the groups.

Approximately 10% of patients developed de novo OAB following HoLEP, leading to impaired postoperative QOL even when postoperative voiding function parameters were similar between the groups. Intraoperative factors, particularly prolonged hemostasis and endoscopic manipulation at the bladder neck, may be associated with this risk. These results suggest the critical role of the intraoperative technique in preventing de novo OAB after HoLEP.