Surgical BPH Effect of Holmium Laser Enucleation of Prostate on Overactive Bladder Symptoms and Urodynamic Parameters: A Prospective Study Ohseong Kwon, Hahn-Ey Lee, Jungbum Bae, Jin Kyu Oh, and Seung-June Oh OBJECTIVE To analyze the effect of Holmium laser enucleation of prostate (HoLEP) on overactive bladder (OAB) symptoms and urodynamic parameters in patients with benign prostatic hyperplasia. METHODS One hundred sixty-five patients were included in this prospective study. They complained of lower urinary tract symptoms suggestive of benign prostatic hyperplasia and underwent HoLEP by a surgeon from January 2010 to March 2012. We analyzed the results of International Prostate Symptom Score, overactive bladder questionnaire, frequency-volume chart, and urodynamic studies (UDS) before and after the surgery. Follow-up examinations were repeated 3 and 6 months postoperatively, and a UDS was performed at 6 months after the surgery. RESULTS The mean age was 68.4 (range, 52-91) years, the preoperative prostate volume measured by transrectal ultrasound was 71.1 (range, 22-202) mL, and the serum PSA level was 4.4 (range, 0.5-21.7) ng/mL. Postoperatively, patients showed significant improvement in the Interna- tional Prostate Symptom Score (total score from 20.7 to 5.5, P <.001), overactive bladder questionnaire score (severity score from 24.8 to 12.5, P <.001), and frequency-volume chart parameters (daytime frequency, nocturia, and maximal capacity, respectively) (P <.001). The peak flow rate (P <.001), postvoid residual urine volume (P <.001), maximal cysto- metric capacity (P <.002), and bladder outlet obstruction index (P <.001) have improved significantly. The number of patients who showed involuntary detrusor contraction in UDS decreased significantly from 45.5% to 36.4% (P <.001). However, bladder compliance did not improve. CONCLUSION OAB symptoms and urodynamic parameters were improved significantly after HoLEP surgery in short-term follow-up. UROLOGY 83: 581e585, 2014. Ó 2014 Elsevier Inc. B enign prostatic hyperplasia (BPH) is a common condition in aged men. Although the mechanism is not yet well known, overactive bladder (OAB) symptoms are highly prevalent in patients with BPH and are bothersome to patients. 1 However, the natural history of OAB symptoms in patients with BPH is not well known. According to previous studies, bladder outlet obstruction (BOO) not only causes lower urinary tract symptoms (LUTS) but also induces secondary bladder dysfunction that results in abnormalities in a urodynamic study (UDS). 2 There have been some reports showing improvement in storage symptoms after the medical treatment for BPH. 3,4 But there have been few studies reporting ana- lyses of the association with OAB symptoms after the surgery. 5 There is debate concerning whether OAB symptoms improve, and if so, how much after the surgery for the relief of BOO. OAB symptoms persisted in 20%- 40% of patients after transurethral prostate surgery. 6 Sometimes, they improve after surgical relief of BOO. 7 Holmium laser enucleation of prostate (HoLEP) was introduced by Gilling et al 8 in 1996. HoLEP is identical with an open prostatectomy in which it relieves anatomic obstruction caused by adenomas. 9 There have been few studies evaluating the effect of HoLEP on OAB- related conditions. However, there are no prospective studies that use objective UDS parameters before and after HoLEP. The aim of this study is to identify the effect of HoLEP on OAB symptoms and urodynamic parameters. Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Seoul National University Hospital, Seoul, South Korea; the Department of Urology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea; and the Department of Urology, Gachon University Gil Hospital, Incheon, South Korea Reprint requests: Seung-June Oh, M.D., Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. E-mail: sjo@ snu.ac.kr Submitted: June 11, 2013, accepted (with revisions): October 24, 2013 ª 2014 Elsevier Inc. 0090-4295/14/$36.00 581 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2013.10.037