Currently, holmium laser enucleation of the prostate (HoLEP) is the standard surgical procedures used to treat benign prostatic hyperplasia (BPH). Several recent studies have demonstrated that the surgical management of BPH in patients with detrusor underactivity (DU) can effectively improve voiding symptoms. On the other hand, there are few reports on the effects of HOLEP on bowel function before and after surgery. Therefore, we evaluated the long-term surgical outcomes of HoLEP, especially voiding function and bowel function in patients with DU using the Expanded Prostate Cancer Index Composite (EPIC).

Patients with DU receiving HOLEP (Group A) and without DU receiving HOLEP (Group B) at our department between 2012 and 2017 were enrolled in this study. QOL was assessed using the EPIC before treatment and 3, 6, 12, 24 and 36 months post-treatment in each group. Urinary, bowel, sexual domains and satisfaction were evaluated. DU was defined as detrusor pressure at Qmax (PdetQmax)<40 cm H₂O as measured by a pressure flow study. All data, presented as means with standard deviation, were evaluated with the Mann-Whitney U test; a P value of less than 0.05 was considered significant.

In Table 1 patients’ characteristics are presented. The number of patients in Group A was 21 and Group B was 61. The comparison of the two groups indicated significant differences in prostate volume (p < 0.05), intra prostatic protrusion (p < 0.05), PdetQmax (p < 0.01) and bladder contractility index (p < 0.01). Figure 1 showed EPIC score between two groups. For urinary summary score, Group B was lower than Group A before HOLEP, but there was no significant difference after surgery. For urinary function, bother, irritative/obstructive and incontinence, there were no significant differences between two groups before and after HOLEP. For bowel summary score, Group A was lower than Group B before HOLEP, but there was no significant difference after surgery. While there was no significant difference in bowel bother, the bowel function in Group A was lower than Group B before and 3 months after HOLEP, but there was no significant difference after 6 months.

This study demonstrated that patients with DU had a lower QOL related to preoperative bowel function, but improved postoperatively to the same degree as patients without DU. The QOL related to urinary function after HOLEP in patients with DU improved similarly to cases without DU. Although there are various causes of DU, many cases with DU are thought to require abdominal pressure during voiding. Improved obstruction may have resulted in improved QOL related to bowel function, along with a reduction in the need for abdominal pressure during voiding.

Our study suggests that HOLEP for patients with DU may improve not only voiding function but also QOL in bowel function. The limitations of this study were the small number of cases. If the number of cases is increased, a more detailed study will be possible in the future.