Improvement in Nocturia Frequency After Holmium Laser Enucleation of the Prostate (HoLEP)

Abstract

Background/Objective: Benign prostatic hyper­plasia (BPH) is a common urinary pathology in older men resulting in lower urinary tract symptoms such as nocturia, urinary frequency and urgency, and outlet obstruction. Holmium enucleation of the prostate (HoLEP) is a bladder outlet procedure used to improve BPH symp­toms by enucleating the prostate’s transitional zone. HoLEP has been demonstrated to improve obstructive urinary symptoms, but little research has investigated the improvement of irritative symptoms like nocturia.

Methods: A retrospective chart review of Indi­ana University HoLEP procedures between Oc­tober 2018 and November 2021 was conduct­ed. Participants were men with a pre-operative American Urology Association Symptom Score (AUASS). At least six months after surgery, patients completed the AUASS to compare pre- and post-operative symptoms. We identified par­ticipants with high frequency nocturia (HFN), a nocturia frequency ≥ 3, low frequency nocturia (LFN), a nocturia frequency < 3, and dominant nocturia (DN), a nocturia frequency ≥ 3 and an AUASS score < 20. Averages and paired two-tailed t-tests were conducted.

Results: We identified 220 patients who com­pleted surveys and follow-up. Overall, noc­turia was reduced by 0.92 points and quality of life (QOL) scores improved by 2.51 points post-HoLEP (p<0.05). HFN patients experi­enced a 2.01-point decrease in nocturia scores (p<0.001) compared to a 0.12 increase in LFN patients (p=0.43) and a 0.85 decrease in DN patients’ scores (p=0.002) after HoLEP. When comparing QOL scores, HFN patients displayed a 2.98-point improvement, LFN participants improved by 2.34, and DN patients indicat­ed a 2.12-point improvement after surgery (p<0.001).

Conclusion/Implications: In patients with high occurrences of nocturia pre-operatively, Ho­LEP demonstrated significant improvements in nocturia frequency. LFN patients did not demonstrate a significant improvement in noc­turia scores. Despite this, all groups displayed improved QOL scores post-operatively. This sug­gests that HoLEP helps reduce irritative symp­toms such as nocturia. Further investigation is needed to evaluate this on a larger scale.