title: Prostatic vascular damage induced by cigarette smoking as a risk factor for recovery after holmium laser enucleation of the prostate (HoLEP).
abstract: OBJECTIVE
  To evaluate the relationship between prostatic vessel changes induced by cigarette smoking and the perioperative outcome of holmium laser enucleation of the prostate (HoLEP).
  
  
  METHODS
  A total of 268 postoperative patients with benign prostatic hyperplasia (BPH) were prospectively analysed in our department. They were divided into two groups (smokers and non-smokers) according to smoking history. Transrectal colour Doppler ultrasound was performed to evaluate the prostate vascular changes. Pathologically, HE staining, CD31 and CD34 were analysed in prostatic section chips. Furthermore, postoperative outcomes were determined during a 6-month follow-up period.
  
  
  RESULTS
  The preoperative prostate volume was significantly decreased in smoking patients (P = 0.04). CPI was significantly lower in smoking BPH patients (P < 0.01), whereas RI was significantly increased in smokers compared with non-smokers (P < 0.01). Histological assays revealed elevated CD34 in the smoking BPH individuals presenting an increased number of microvessels. The HoLEP duration was increased in smokers. Interestingly, we identified significantly increased overactive bladder syndrome score (OABSS) and decreased Qmax in smoking individuals during the 6-month follow-up with no difference being observed preoperatively. However, no significant difference between the groups was observed for the International Prostate Symptom Score (IPSS).
  
  
  CONCLUSIONS
  The significantly lower CPI and higher RI values in smoking BPH patients indicated the presence of considerable vascular damage in these subjects. Moreover, cigarette smoking extended the surgical duration and prolonged the recovery period of overactive bladder (OAB) syndrome. Thus, integrated treatment should be suggested for various BPH individuals.
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Chong
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Gu
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yanbo
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhikang
authors.initials: Z
authors.lastname: Cai
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006695:Holmium; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D018615:Ultrasonography, Doppler, Color
chemical_list: D006695:Holmium
keywords: benign prostatic hyperplasia; holmium laser enucleation of the prostate; perioperative characteristics; smoking; vascular damage