Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) may cause storage symptoms in men [1]. Although surgeries for BPH such as Holmium laser enucleation of the prostate (HoLEP) has been proved to improve lower urinary tract symptoms, a certain number of patients continues to complain storage symptoms [2, 3]. This study aims to investigate the predisposing factors of the persistent storage symptoms after HoLEP in BPH patients and their correlations to the recovery period of the symptoms.

A total of 127 BPH patients complaining storage symptoms that underwent HoLEP from May 2014 to June 2017 were included in the study. International Prostatic Symptom Score (IPSS), overactive bladder symptom score (OABSS) questionnaire and urodynamic studies were conducted preoperatively in these patients. The patients were divided into two groups depending on the persistence of storage symptoms (IPSS storage score > 8 or OABSS > 5) at three months after the surgery. The data of the patients with persistent storage symptoms (group I) were analyzed and compared to those without the symptoms (group II) to validate the predisposing factors for postoperative persistent storage symptoms. In group I, the correlation between the predisposing factors and recovery period of the storage symptoms was analyzed in each patient.

Among the 127 patients, 68 and 59 patients were sorted into group I and II, respectively. Among the compared data in the two groups (Table 1), group I presented significantly greater mean age (p = 0.015), mean peak detrusor overactivity (DO) amplitude (p = 0.039) and mean MCC (p = 0.042). Multivariable analysis which was performed by using these three variables presented that only mean age (p = 0.024) and mean peak DO amplitude (p = 0.048) were statistically significant. Among the patients from group I, storage symptoms did not recover until 12 postoperative months in 12 patients (17.64 %), and their age was the only variable that was significantly different from the other patients (77.28 ± 15.55 vs 71.81 ± 32.57 years, p = 0.045).

According to comparative analysis of the variables, patients who had older age, higher peak DO amplitude and greater MCC presented persistent storage symptoms after HoLEP at 3 months. However, multivariable analysis revealed that only advanced age and high peak DO amplitude were the predisposing factors that impeded the alleviation of storage symptoms after three months from the surgery. Most of the patients were free from storage symptoms at a year after HoLEP except 12 patients who were significantly older than others. Such results imply that age is the most critical factor that inhibits the recovery of bladder from storage symptoms after BPH surgery.

Old age and high peak DO amplitude were the predictors for persistent storage symptoms after HoLEP. Also, older patients were unlikely to recover storage symptoms until 12 months from the surgery.

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