title: The Impact of Increased Bladder Blood Flow on Storage Symptoms after Holmium Laser Enucleation of the Prostate.
abstract: In order to investigate how holmium laser enucleation of the prostate (HoLEP) improves urinary storage symptoms, we assessed blood flow in the urinary bladder mucosa of patients with benign prostatic hyperplasia (BPH) before and after laser surgery. Seventy-four consecutive patients with BPH (median age 69 years, range; 53-88) underwent HoLEP at our institution and are included in this study. We prospectively assessed the International Prostate Symptom Score (IPSS), IPSS-QOL Score, the Overactive Bladder Symptom Score (OABSS), uroflowmetry, and blood flow in the urinary bladder, before and after surgery. Blood flow in the bladder mucosa was measured using the OMEGA FLOW (OMEGAWAVE, Tokyo, Japan) laser Doppler flowmeter. The median volume of the enucleated adenomas was 45.0 g (range: 25.0 to 83.2). The median IPSS improved significantly from 20 (range: 6-35) to 3 (0-22) (p < 0.001; Wilcoxon signed-rank test), as did the storage symptoms score, which decreased from 13 (2-20) to 3 (1-8) (p < 0.001). Median bladder blood flow increased at the trigone from 9.57 ± 0.83 ml/sec to 17.60 ± 1.08 ml/sec. Multiple regression analysis for the improved storage symptom score eliminated all explanatory variables except increased bladder perfusion. The data suggest that HoLEP improves blood flow in the bladder mucosa, which independently leads to the improvement of storage symptoms.
authors.affiliation: Department of Urology, Teikyo University, School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Hisasue
authors.affiliation: Department of Urology, Teikyo University, School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Aoki
authors.affiliation: Department of Urology, Teikyo University, School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Muto
authors.affiliation: Department of Urology, Teikyo University, School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Raizo
authors.initials: R
authors.lastname: Yamaguchi
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tsujimura
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006695:Holmium; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000098:blood supply / Q000000981:diagnostic imaging; D011470:Prostatic Hyperplasia / Q000601:surgery; D012039:Regional Blood Flow; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D014463:Ultrasonography; D001743:Urinary Bladder / Q000098:blood supply* / Q000000981:diagnostic imaging
chemical_list: D006695:Holmium