Effect of Urinary Retention on Photoselective Laser Vaporization Prostatectomy Outcome

Abstract

Introduction: The objective of this study was to evaluate the effect of acute urinary retention (AUR) on the outcome of photoselective vaporization of the prostate (PVP) patients and to compare postoperative results between patients with and without preoperative retention. Methods: A total of 476 patients who underwent photoselective laser vaporization prostatectomy for voiding difficulty at a single center were included in this study. Transrectal ultrasound (TRUS) and urodynamic studies (UDS), serum prostate specific antigen (PSA), maximum urine flow rate(Qmax), post void residue (PVR), voiding diary parameters, international prostatic symptom score (IPSS), uroflowmetry (UFM), were collected at baseline, 2 week, 1 month, 3 month, 6 month, 12 month and then annually up to 3 years postoperatively. Subjects were divided into AUR group and non-AUR group to analyze clinical parameters. Results: Mean total IPSS of the entire sample was 20±8.7 and mean Qmax 10.24±7.34 ml/sec. Mean PVR was 87.56±120.4ml. After 1 year postoperative follow-up, post-operative IPSS was reduced to 10.87±8.09 and mean Qmax increased to 16.3±20.01 ml/sec. A total of 91 patients had at least one episode of AUR. When comparing both groups, there were significant differences in age (mean 71.75±8.88 vs. 68.01±7.70 years), PSA (10.81±14.78 vs. 3.94±6.19 ng/ml), BMI (22.65±3.23 vs. 24.15±3.01), and prostate size (69.14±40.93 vs. 48.92±29.82 ml). UFM report in the first 2 weeks showed that the AUR group had lower Qmax (11.38±5.46 vs. 14.44±7.79 ml/sec) and higher PVR but on later follow-ups there was no significant difference. On 1 year follow-up the total IPSS was 7.57±6.79 for the AUR group and 11.42±8.17 for the NUR showing a more significant improvement in the AUR group (p=0.018). However, the AUR group had a risk of 4.6 times higher to have immediate postoperative retention than the NUR group. Urodynamic data showed that only MUP (82.89±30.17 vs. 91.79±26.21), MCC (373±103.62 vs. 403.69±71.65), PdetQmax (58.75±22.52 vs. 49.13±25.82) and BOO index (45.50±23.68 vs. 32.54±27.97) had significant differences. Conclusions: Almost all patients had improvements in subjective and objective voiding parameters after PVP regardless of the presence of preoperative AUR but those with history of acute urinary retention have higher risk of having immediate postoperative voiding failure.