Long-term Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Detrusor Underactivity or Acontractility

Objective To evaluate long-term outcomes for men with benign prostatic obstruction (BPO) and concurrent detrusor underactivity (DUA) or acontractility following holmium laser enucleation of the prostate (HoLEP). Methods A retrospective chart review was performed on all patients with BPO and urodynamic evidence of DUA or acontractility secondary to a nonneurogenic etiology that underwent HoLEP at our institution over a 4-year period. Patients were included if they had at least 24 months of follow-up. Results We identified 9 patients with DUA and 8 patients with acontractility who met inclusion criteria with median ages of 76 and 75 years, respectively. Preoperatively, 7 (77.8%) men with DUA and 8 (100%) men with acontractility had catheter-dependent urinary retention for a median of 2 and 5 months, respectively. Postoperatively, 8 (88.9%) men with DUA and 5 (62.5%) men with acontractility were catheter free, with a median follow-up of 50.9 and 38.6 months, respectively. All the men requiring catheterization were voiding spontaneously, but used intermittent catheterization for elevated postvoid residuals. Conclusion HoLEP appears to be an effective surgical option for patients with BPO and detrusor hypocontractility or acontractility, with durable results at follow-up greater than 24 months. However, patients with acontractile bladders should be counseled on possible need to for intermittent catheterization that may be needed for high postvoid residuals.