title: Postoperative Lower Urinary Tract Storage Symptoms: Does Prostate Enucleation Differ from Prostate Vaporization for Treatment of Symptomatic Benign Prostatic Hyperplasia?
abstract: OBJECTIVE
  To assess the degree of postoperative storage symptoms after GreenLight™ laser photoselective vaporization of the prostate (PVP) and Holmium laser enucleation of the prostate (HoLEP) for management of benign prostatic hyperplasia (BPH) and its predictors.
  
  
  METHODS
  A retrospective review was performed for patients who underwent HoLEP or PVP for non catheter-dependent patients with BPH. Patients were followed up at 1, 3, 6, and 12 months and then annually by International Prostate Symptoms Score (IPSS), quality of life index, peak flow rate, residual urine volume, and prostate-specific antigen (PSA) level. Moderate or severe storage symptoms were defined as IPSS storage subscore ≥ 9.
  
  
  RESULTS
  Of 1673 laser procedures, a total of 1100 procedures met the inclusion criteria including 809 HoLEPs and 291 PVPs. The HoLEP group had significantly larger preoperative prostates and longer operative time. In the HoLEP group, postoperative IPSS was significantly better than in the PVP group at all follow-up points (P<0.05). Storage subscore was significantly higher after PVP and did not improve until 6 months postoperatively when it became comparable with that of the HoLEP group. The number of patients with IPSS-storage score ≥ 9 were significantly higher in the PVP group at 1 and 3 months follow-up (37.3% vs 15.1%, P<0.001) and (26.4% vs 17.5%, P=0.004), respectively. XPS-180W was associated with the lowest storage symptoms among the three GreenLight generations at all follow-up visits. In multivariate analysis, baseline IPSS-storage subscore ≥ 9, prolonged operative time >100 minutes, and lower percent of postoperative PSA level reduction significantly predicted less improvement of postoperative storage symptoms regardless of the laser procedure.
  
  
  CONCLUSIONS
  Storage urinary symptoms significantly improved more after HoLEP compared with PVP, irrespective of the generation of GreenLight laser used. Recovery from bothersome storage urinary symptoms after prostate vaporization is time dependent, and baseline degree of storage symptoms, prolonged operative time, and lower percent of postoperative PSA level reduction negatively predicts postoperative improvement of storage symptoms regardless of the laser procedure.
authors.affiliation: 1 Department of Surgery, Division of Urology, McGill University Health Centre , Montreal, Quebec, Canada .|2 Department of Urology, Suez Canal University , Ismailia, Egypt .
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.affiliation: 1 Department of Surgery, Division of Urology, McGill University Health Centre , Montreal, Quebec, Canada .|3 Urology and Nephrology Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: 1 Department of Surgery, Division of Urology, McGill University Health Centre , Montreal, Quebec, Canada .
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Elhilali
mesh_terms: D000368:Aged; D006695:Holmium; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008027:Light; D059411:Lower Urinary Tract Symptoms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000379:methods; D014551:Urinary Tract / Q000601:surgery; D014835:Volatilization
chemical_list: D017430:Prostate-Specific Antigen; D006695:Holmium