Efficacy of Holmium Laser Enucleation of the Prostate Based on Patient Preoperative Characteristics

PURPOSE To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in relation to prostate size and urodynamic parameters, including bladder outlet obstruction index (BOOI), presence of detrusor overactivity, and detrusor contractility, and to investigate factors predictive of HoLEP success. METHODS This retrospective analysis of prospective data included 174 consecutive patients treated with HoLEP at Samsung Medical Center from 2009 to 2013. Prostate-specific antigen, prostate size, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) were evaluated preoperatively, while prostate-specific antigen, uroflowmetry/postvoid residual (PVR) urine, and IPSS were measured six months after HoLEP. Two definitions of treatment success were established based on the following three variables: IPSS, maximum flow rate (Qmax), and QoL index. Factors predictive of HoLEP success were identified using multiple logistic regression analysis. RESULTS IPSS/QoL, Qmax, and PVR improved significantly following HoLEP. Improvements in IPSS and PVR were more significant in the BOOI≥40 group compared to the BOOI<40 group, with overall success rates of 93.7% and 73.6%, respectively. Thus, the BOOI≥40 group had a significantly higher success rate, and BOOI≥40 was a significant predictor of HoLEP success based on the multivariate analyses. CONCLUSIONS We found good surgical outcomes after HoLEP, and specifically patients with a higher BOOI had a greater chance of surgical success.