In the Era of Holmium Laser Enucleation of the Prostate Is Preoperative Urodynamics Required for Men in Urinary Retention?

The goal of this review is to challenge the dogma that urodynamics is required to identify detrusor underactivity and bladder outlet obstruction for men in urinary retention prior to offering any bladder outlet surgery in the era of holmium laser enucleation of the prostate (HoLEP). Classically, bladder outlet surgery was not recommended for patients with detrusor underactivity as men with detrusor underactivity who underwent transurethral resection of the prostate (TURP) had worse outcomes than those who underwent TURP for bladder outlet obstruction without detrusor underactivity. We review the evidence from TURP studies that led to the traditional teaching and review the latest research on the utility of urodynamics prior to HoLEP.

For men in urinary retention, HoLEP has more positive postoperative voiding outcomes than were noted with TURP and very high rates of spontaneous voiding even for men with urodynamics-proven detrusor underactivity or bladder acontractility.

We challenge the traditional teaching that UDS is required to identify detrusor underactivity and bladder outlet obstruction prior to performing HoLEP. We argue that routine UDS prior to HoLEP is not necessary for men in urinary retention.