Improved bladder blood flow aids laser BPH therapy

NEW YORK - As well as easing passage of urine in patients with benign prostatic hypertrophy (BPH), holmium laser enucleation of the prostate (HoLEP) may provide a beneficial increase in bladder blood flow, according to Japanese researchers.

As Dr. Shigeo Horie told Reuters Health by email, HoLEP "improves not only urinary obstructive symptoms but urinary storage symptoms of BPH. But the underlying mechanism has been unknown."

In a June 19 online paper in PLoS One, Dr. Shigeo, of Juntendo University, Tokyo, and colleagues note that to investigate, they assessed blood flow in the urinary bladder mucosa of 72 patients before and after HoLEP.

The researchers point out, "In patients with BPH there is often continuous over-distention of the bladder due to incomplete voiding. This sustained increase in residual urine results in decreased bladder blood flow." These and other findings "indicate that chronic bladder ischemia is associated with irritative and/or storage symptoms of the lower urinary tract in BPH."

Following laser treatment, the median bladder blood flow increased at the trigone from 9.57 mL/sec to 17.60 mL/sec. In 48 of the patients, bladder perfusion was significantly increased. The change was less than 5% in the remaining 26 patients.

Overall, the median volume of the enucleated adenomas was 45 g. The median International Prostate Symptom Score fell significantly from 20 to 3 and the storage symptoms score decreased significantly from 13 to 3.

Moreover, say the investigators, "multivariate linear regression analysis demonstrated increased blood perfusion of the bladder to be the only clinical parameter associated with improved storage."

"This," concluded Dr. Horie, "is the first study that demonstrates that HoLEP improves blood flow in the bladder mucosa, which independently leads to the improvement of storage symptoms. Thus, chronic ischemia of the bladder can cause urinary storage symptoms and microperfusion could be a future target for the pharmacotherapy of BPH."

The authors reported no funding or disclosures.


PLoS One 2015.

References: Reuters Health
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