The Impact of Increased Bladder Blood Flow on Storage Symptoms after Holmium Laser Enucleation of the Prostate
Keisuke Saito, Shin-ichi Hisasue, Hisamitsu Ide, Hiroaki Aoki, Satoru Muto, Raizo Yamaguchi, Akira Tsujimura, Shigeo Horie, Keisuke Saito, Shin-ichi Hisasue, Hisamitsu Ide, Hiroaki Aoki, Satoru Muto, Raizo Yamaguchi, Akira Tsujimura, Shigeo Horie
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.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
Figures
1A: LDF employs a beam of low intensity monochromatic infrared light emitted from a laser diode within the flowmeter to measure the real-time micro-perfusion rate at tissue depths of 1 mm. B: The probe is placed a few mm away from the bladder mucosa while the bladder is filled with 150 ml saline at room temperature.
There was significant improvement 1 week after surgery (*: p Fig 3. Bladder blood flow measured by LDF.
Fig 3. Bladder blood flow measured by…
Fig 3. Bladder blood flow measured by LDF.
Every region of the bladder including left…
Every region of the bladder including left wall, right wall, and bladder trigone showed a significant increase in blood flow as measured by LDF. *: p Fig 4. The change in voided volume.
Fig 4. The change in voided volume.
Fig 4. The change in voided volume.
The change in voided volume is shown before…
The change in voided volume is shown before and after surgery for both the increased perfusion group and the no change group. *: p Fig 5. The improvement rate of IPSS and OABSS.
Fig 5. The improvement rate of IPSS…
Fig 5. The improvement rate of IPSS and OABSS.
(A) shows the improvement rate of…
(A) shows the improvement rate of storage symptoms in IPSS for both the increased perfusion group and the no change group. (B) shows the improvement rate of OABSS storage symptoms for the increased perfusion group and the no change group.*: p
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References
-
- Mostwin JL. Pathophysiology: the varieties of bladder overactivity. Urology. 2002;60(5 Suppl 1):22–6; discussion 7. Epub 2002/12/21 . - PubMed
-
- Abrams PH, Farrar DJ, Turner-Warwick RT, Whiteside CG, Feneley RC. The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol. 1979;121(5):640–2. Epub 1979/05/01 . - PubMed
Show all 12 references
MeSH terms
- Aged
- Aged, 80 and over
- Holmium*
- Humans
- Laser Therapy*
- Male
- Middle Aged
- Mucous Membrane / blood supply
- Mucous Membrane / diagnostic imaging
- Prostatic Hyperplasia / surgery
- Regional Blood Flow*
- Transurethral Resection of Prostate*
- Treatment Outcome
- Ultrasonography
- Urinary Bladder / blood supply*
- Urinary Bladder / diagnostic imaging
Substances
- Holmium
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The authors have no support or funding to report.
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Every region of the bladder including left wall, right wall, and bladder trigone showed a significant increase in blood flow as measured by LDF. *: p Fig 4. The change in voided volume.
Fig 4. The change in voided volume.
Fig 4. The change in voided volume.
The change in voided volume is shown before…
The change in voided volume is shown before and after surgery for both the increased perfusion group and the no change group. *: p Fig 5. The improvement rate of IPSS and OABSS.
Fig 5. The improvement rate of IPSS…
Fig 5. The improvement rate of IPSS and OABSS.
(A) shows the improvement rate of…
(A) shows the improvement rate of storage symptoms in IPSS for both the increased perfusion group and the no change group. (B) shows the improvement rate of OABSS storage symptoms for the increased perfusion group and the no change group.*: p
Similar articles
- Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH).Elshal AM, Elmansy HM, Elhilali MM. Elshal AM, et al. BJU Int. 2012 Dec;110(11 Pt C):E845-50. doi: 10.1111/j.1464-410X.2012.11290.x. Epub 2012 Jun 15. BJU Int. 2012. PMID: 22702908
- Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate.Elshal AM, Elkoushy MA, Elmansy HM, Sampalis J, Elhilali MM. Elshal AM, et al. J Urol. 2014 Jan;191(1):148-54. doi: 10.1016/j.juro.2013.06.113. Epub 2013 Jul 8. J Urol. 2014. PMID: 23845460
- Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g.Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Gupta N, et al. BJU Int. 2006 Jan;97(1):85-9. doi: 10.1111/j.1464-410X.2006.05862.x. BJU Int. 2006. PMID: 16336334 Clinical Trial.
- Holmium laser enucleation of the prostate and holmium laser ablation of the prostate: indications and outcome.Suardi N, Gallina A, Salonia A, Briganti A, Dehò F, Zanni G, Abdollah F, Naspro R, Cestari A, Guazzoni G, Rigatti P, Montorsi F. Suardi N, et al. Curr Opin Urol. 2009 Jan;19(1):38-43. doi: 10.1097/MOU.0b013e32831a7008. Curr Opin Urol. 2009. PMID: 19057214 Review.
- Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature.Shah HN, Mahajan AP, Hegde SS, Bansal MB. Shah HN, et al. BJU Int. 2007 Jul;100(1):94-101. doi: 10.1111/j.1464-410X.2007.06867.x. Epub 2007 Apr 5. BJU Int. 2007. PMID: 17419697 Review.
Cited by
- Molecular Regulation of Concomitant Lower Urinary Tract Symptoms and Erectile Dysfunction in Pelvic Ischemia.Tarcan T, Choi HP, Azadzoi KM. Tarcan T, et al. Int J Mol Sci. 2022 Dec 15;23(24):15988. doi: 10.3390/ijms232415988. Int J Mol Sci. 2022. PMID: 36555629 Free PMC article. Review.
- A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe.Rücker F, Lehrich K, Böhme A, Zacharias M, Ahyai SA, Hansen J. Rücker F, et al. World J Urol. 2021 Jul;39(7):2337-2345. doi: 10.1007/s00345-021-03598-5. Epub 2021 Jan 24. World J Urol. 2021. PMID: 33486536 Clinical Trial.
- Efficacy of Holmium Laser Enucleation of the Prostate in Patients with a Small Prostate (≤30 mL).Park S, Kwon T, Park S, Moon KH. Park S, et al. World J Mens Health. 2017 Dec;35(3):163-169. doi: 10.5534/wjmh.17011. Epub 2017 Nov 20. World J Mens Health. 2017. PMID: 29164833 Free PMC article.
- Holmium laser enucleation of the prostate followed by high-intensity focused ultrasound treatment for patients with huge prostate adenoma and localized prostate cancer: 5-Year follow-up.Horiuchi A, Muto S, Horie S. Horiuchi A, et al. Prostate Int. 2016 Jun;4(2):49-53. doi: 10.1016/j.prnil.2016.01.001. Epub 2016 Jan 22. Prostate Int. 2016. PMID: 27358843 Free PMC article.
References
-
- Mostwin JL. Pathophysiology: the varieties of bladder overactivity. Urology. 2002;60(5 Suppl 1):22–6; discussion 7. Epub 2002/12/21 . - PubMed
-
- Abrams PH, Farrar DJ, Turner-Warwick RT, Whiteside CG, Feneley RC. The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol. 1979;121(5):640–2. Epub 1979/05/01 . - PubMed
Show all 12 references
MeSH terms
- Aged
- Aged, 80 and over
- Holmium*
- Humans
- Laser Therapy*
- Male
- Middle Aged
- Mucous Membrane / blood supply
- Mucous Membrane / diagnostic imaging
- Prostatic Hyperplasia / surgery
- Regional Blood Flow*
- Transurethral Resection of Prostate*
- Treatment Outcome
- Ultrasonography
- Urinary Bladder / blood supply*
- Urinary Bladder / diagnostic imaging
Substances
- Holmium
Related information
Grant support
The authors have no support or funding to report.
LinkOut - more resources
- Full Text Sources
- Other Literature Sources
- Medical
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Send To [x]
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
Follow NCBI
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
The change in voided volume is shown before and after surgery for both the increased perfusion group and the no change group. *: p Fig 5. The improvement rate of IPSS and OABSS.
Fig 5. The improvement rate of IPSS…
Fig 5. The improvement rate of IPSS and OABSS.
(A) shows the improvement rate of…
(A) shows the improvement rate of storage symptoms in IPSS for both the increased perfusion group and the no change group. (B) shows the improvement rate of OABSS storage symptoms for the increased perfusion group and the no change group.*: p
Similar articles
- Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH).Elshal AM, Elmansy HM, Elhilali MM. Elshal AM, et al. BJU Int. 2012 Dec;110(11 Pt C):E845-50. doi: 10.1111/j.1464-410X.2012.11290.x. Epub 2012 Jun 15. BJU Int. 2012. PMID: 22702908
- Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate.Elshal AM, Elkoushy MA, Elmansy HM, Sampalis J, Elhilali MM. Elshal AM, et al. J Urol. 2014 Jan;191(1):148-54. doi: 10.1016/j.juro.2013.06.113. Epub 2013 Jul 8. J Urol. 2014. PMID: 23845460
- Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g.Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Gupta N, et al. BJU Int. 2006 Jan;97(1):85-9. doi: 10.1111/j.1464-410X.2006.05862.x. BJU Int. 2006. PMID: 16336334 Clinical Trial.
- Holmium laser enucleation of the prostate and holmium laser ablation of the prostate: indications and outcome.Suardi N, Gallina A, Salonia A, Briganti A, Dehò F, Zanni G, Abdollah F, Naspro R, Cestari A, Guazzoni G, Rigatti P, Montorsi F. Suardi N, et al. Curr Opin Urol. 2009 Jan;19(1):38-43. doi: 10.1097/MOU.0b013e32831a7008. Curr Opin Urol. 2009. PMID: 19057214 Review.
- Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature.Shah HN, Mahajan AP, Hegde SS, Bansal MB. Shah HN, et al. BJU Int. 2007 Jul;100(1):94-101. doi: 10.1111/j.1464-410X.2007.06867.x. Epub 2007 Apr 5. BJU Int. 2007. PMID: 17419697 Review.
Cited by
- Molecular Regulation of Concomitant Lower Urinary Tract Symptoms and Erectile Dysfunction in Pelvic Ischemia.Tarcan T, Choi HP, Azadzoi KM. Tarcan T, et al. Int J Mol Sci. 2022 Dec 15;23(24):15988. doi: 10.3390/ijms232415988. Int J Mol Sci. 2022. PMID: 36555629 Free PMC article. Review.
- A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe.Rücker F, Lehrich K, Böhme A, Zacharias M, Ahyai SA, Hansen J. Rücker F, et al. World J Urol. 2021 Jul;39(7):2337-2345. doi: 10.1007/s00345-021-03598-5. Epub 2021 Jan 24. World J Urol. 2021. PMID: 33486536 Clinical Trial.
- Efficacy of Holmium Laser Enucleation of the Prostate in Patients with a Small Prostate (≤30 mL).Park S, Kwon T, Park S, Moon KH. Park S, et al. World J Mens Health. 2017 Dec;35(3):163-169. doi: 10.5534/wjmh.17011. Epub 2017 Nov 20. World J Mens Health. 2017. PMID: 29164833 Free PMC article.
- Holmium laser enucleation of the prostate followed by high-intensity focused ultrasound treatment for patients with huge prostate adenoma and localized prostate cancer: 5-Year follow-up.Horiuchi A, Muto S, Horie S. Horiuchi A, et al. Prostate Int. 2016 Jun;4(2):49-53. doi: 10.1016/j.prnil.2016.01.001. Epub 2016 Jan 22. Prostate Int. 2016. PMID: 27358843 Free PMC article.
References
-
- Mostwin JL. Pathophysiology: the varieties of bladder overactivity. Urology. 2002;60(5 Suppl 1):22–6; discussion 7. Epub 2002/12/21 . - PubMed
-
- Abrams PH, Farrar DJ, Turner-Warwick RT, Whiteside CG, Feneley RC. The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol. 1979;121(5):640–2. Epub 1979/05/01 . - PubMed
Show all 12 references
MeSH terms
- Aged
- Aged, 80 and over
- Holmium*
- Humans
- Laser Therapy*
- Male
- Middle Aged
- Mucous Membrane / blood supply
- Mucous Membrane / diagnostic imaging
- Prostatic Hyperplasia / surgery
- Regional Blood Flow*
- Transurethral Resection of Prostate*
- Treatment Outcome
- Ultrasonography
- Urinary Bladder / blood supply*
- Urinary Bladder / diagnostic imaging
Substances
- Holmium
Related information
Grant support
The authors have no support or funding to report.
LinkOut - more resources
- Full Text Sources
- Other Literature Sources
- Medical
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Send To [x]
(A) shows the improvement rate of storage symptoms in IPSS for both the increased perfusion group and the no change group. (B) shows the improvement rate of OABSS storage symptoms for the increased perfusion group and the no change group.*: p
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