title: Metabolic syndrome is predictive of lower urinary tract symptom improvement after holmium laser enucleation of the prostate for benign prostatic obstruction.
abstract: OBJECTIVE
  To investigate the effect of metabolic syndrome (MS) on patient outcomes who underwent holmium laser enucleation of the prostate (HoLEP) for benign prostatic obstruction.
  
  
  METHODS
  Data from 151 patients who underwent HoLEP by a single surgeon between March 2012 and March 2016 were retrospectively analyzed. Patients with MS were assigned to group 1 (n = 33) and patients without MS in group 2 (n = 118). Clinical characteristics and the International Prostate Symptom Score (IPSS), including quality of life (QoL), peak urinary flow rate (Qmax), and postvoid residual urine (PVR), before surgery and 3 months afterward were compared between groups. Additionally, predictors of total IPSS improvement after HoLEP were assessed.
  
  
  RESULTS
  Compared with group 2 patients, group 1 patients were older (70.3 vs. 65.2 years old, p = 0.001). Preoperative data, which included prostate volume, QoL, Qmax, and PVR, were not different between groups. For all patients, both the storage subscore and voiding subscore significantly decreased after surgery (p < 0.001). Postoperative total IPSS and voiding subscore improvement in group 1 were lower than in group 2 (total IPSS improvement 9.2 vs. 12.5, p = 0.042; voiding subscore improvement 6.6 vs. 8.8, p = 0.048). Multivariate analysis showed preoperative total IPSS (β = 0.79, CI 0.71-0.94, p < 0.001) and number of MS components (β = -0.15, CI -2.04 to -0.29, p = 0.009) were independently associated with total IPSS improvement.
  
  
  CONCLUSIONS
  We found that MS was associated with decreased postoperative symptom improvement. Thus, lower urinary tract symptoms after surgery may be a systemic disorder due to multiple metabolic risk factors.
authors.affiliation: Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea.
authors.forename: Taekmin
authors.initials: T
authors.lastname: Kwon
authors.affiliation: Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea.
authors.forename: Sejun
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea.
authors.forename: Sungchan
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea. urofirst@hanmail.net.
authors.forename: Kyung Hyun
authors.initials: KH
authors.lastname: Moon
mesh_terms: D000368:Aged; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000601:surgery*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014563:Urodynamics
keywords: Holmium; Metabolic syndrome; Prostate hyperplasia; Transurethral resection of prostate