Clinical Outcomes in Patients with Hypocontractile Bladders Undergoing Holmium Laser Enucleation of the Prostate

Objective To compare post-operative outcomes in patients who underwent holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and had urodynamic evidence of bladder hypocontractility versus those with normocontractile bladders. Methods We retrospectively reviewed HoLEP patients with pre-operative urodynamic studies at a single institution, categorizing them into normocontractile and hypocontractile groups based on the bladder contractility index (BCI) (hypocontractile defined as BCI < 100). Post-void residual (PVR) volume was measured at 6 weeks and 6 months. Secondary outcomes included maximum flow rate (Qmax) and catheterization status. Results Among 114 HoLEP patients with pre-operative urodynamic data, 49 had hypocontractile bladders. The median pre-operative PVR was 305 (202-446) ml in the hypocontractile group, higher than the median PVR of 190 (60-361) ml in the normocontractile group (p=.013). At 6 weeks post-op, the median PVR was higher in the hypocontractile compared to normocontractile group [38 (3-61) vs. 5 (0-44) ml, p=.016], but at 6 months post-op there was no significant difference [18 (0-39) vs. 12 (0-70) ml, p=.97]. Among men who were catheter-dependent pre-operatively, 98% of hypocontractile and 100% of normocontractile patients were catheter-free postoperatively. Qmax and symptom scores were similar at both follow-up time points. Conclusions HoLEP can be an effective surgical option for BPH patients with hypocontractile bladders, including those who are catheter-dependent, with minimal differences in post-operative voiding parameters compared to those with normal bladder function.