The prevalence of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) increases with age. Detrusor underactivity (DU) is also more common in elderly patients. However, there is no standard diagnostic criterion for DU up to date. We applied various diagnostic criteria to evaluate the patients’ perspectives and the outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with BPH and suspected DU. This study would contribute to give an answer to what kind of diagnostic criterion should be adopted for pre-operative evaluation of BPH surgery and prediction of prognosis in patients with BPH and DU.

We retrospectively reviewed the medical records of 243 patients who underwent HoLEP from May 2012 to February 2017. Ninety three patients who underwent pre-operative urodynamic study and followed-up for more than 3 months postoperatively were enrolled in the study. Preoperative evaluation included international prostate symptom score (IPSS), transrectal ultrasound (TRUS), uroflowmetry, and urodynamic study. At postoperative 3 months, IPSS, uroflowmetry, and peri-operative surgical outcomes were evaluated. The diagnostic criteria for detrusor underactivity were compared using the criteria presented in the literature. Subjective and objective parameters were compared between patients who were included to each DU diagnostic criteria and those who were not.

Of 93 patients, The prevalence of DU, based on each criterion [Bladder contractility index (BCI), Abrams-Griffith (AG) number criteria, pdetQmax<30 criteria, and bladder voiding efficiency (BVE) <90% criteria], was 31.2, 12.9, 11.8, and 9.7%., respectively. When patients were classified by BCI, AG number criteria, and pdetQmax<30 criteria, no significant differences were observed in changes of subjective and objective voiding symptoms between DU and control groups. However, the changes of IPSS-voiding subscore were significantly different between DU and control groups when classified by BVE<90% criteria.

BVE<90% criteria may be superior to other criteria to distinguish true DU in the patients with LUTS/BPH.

Our results showed that HoLEP can be a good option even in the patients with BPH and DU. This study demonstrated that BVE<90% criteria may be superior to other criteria to distinguish true DU in the patients with LUTS/BPH. This criterion can be helpful to predict the postoperative prognosis of patients with LUTS/BPH.