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Metabolic syndrome is predictive of lower urinary tract symptom improvement after holmium laser enucleation of the prostate for benign prostatic obstruction.

PURPOSE: To investigate the effect of metabolic syndrome (MS) on patient outcomes who underwent holmium laser enucleation of the prostate (HoLEP) for benign prostatic obstruction.

MATERIALS AND METHODS: Data from 151 patients who underwent HoLEP by a single surgeon between March 2012 and March 2016 were retrospectively analyzed. Patients with MS were assigned to group 1 (n = 33) and patients without MS in group 2 (n = 118). Clinical characteristics and the International Prostate Symptom Score (IPSS), including quality of life (QoL), peak urinary flow rate (Qmax), and postvoid residual urine (PVR), before surgery and 3 months afterward were compared between groups. Additionally, predictors of total IPSS improvement after HoLEP were assessed.

RESULTS: Compared with group 2 patients, group 1 patients were older (70.3 vs. 65.2 years old, p = 0.001). Preoperative data, which included prostate volume, QoL, Qmax, and PVR, were not different between groups. For all patients, both the storage subscore and voiding subscore significantly decreased after surgery (p < 0.001). Postoperative total IPSS and voiding subscore improvement in group 1 were lower than in group 2 (total IPSS improvement 9.2 vs. 12.5, p = 0.042; voiding subscore improvement 6.6 vs. 8.8, p = 0.048). Multivariate analysis showed preoperative total IPSS (β = 0.79, CI 0.71-0.94, p < 0.001) and number of MS components (β = -0.15, CI -2.04 to -0.29, p = 0.009) were independently associated with total IPSS improvement.

CONCLUSIONS: We found that MS was associated with decreased postoperative symptom improvement. Thus, lower urinary tract symptoms after surgery may be a systemic disorder due to multiple metabolic risk factors.

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