Benign prostatic hypertension (BPH) patients who smoke have considerable vascular damage, and are more likely to undergo a longer prostate laser surgery than non-smokers and to recover more slowly from overactive bladder (OAB) syndrome, a new study reported.

The study, “Prostatic vascular damage induced by cigarette smoking as a risk factor for recovery after holmium laser enucleation of the prostate (HoLEP)” was published in the journal Oncotarget.  Its researchers propose an integrated treatment for BPH patients who smoke that includes a pre-surgery quit-smoking program to lessen vascular damage and improve OAB recovery.

To assess the relationship between blood vessel changes that occur in the prostate as a result of cigarette smoking and the outcome of prostate surgery, researchers at Shanghai Jiaotong University School of Medicine in China prospectively analyzed 268 BPH patients following HoLEP, or holmium laser enucleation of the prostate, a treatment for bladder outflow obstruction due to BPH.

Patients were divided into two groups, those who were smokers and those who were not. Changes in prostate blood vessels were measured using transrectal color Doppler ultrasound (CDUS), a non-invasive technique that measures blood flow.

The results showed that the volume of the prostate before surgery was significantly lower in smokers compared to non-smokers. Tissue analysis also revealed that patients who smoked had an increased number of micro vessels in their prostate.

Color pixel intensity (CPI), an accurate measure of blood flow, was also seen to be significantly lower in smokers, while the resistive index (RI), which represents both blood flow and pressure, was significantly higher in these patients. Finally, the duration of the surgery was increased in smokers compared to non-smokers.

Interestingly, the researchers identified a significant increase in overactive bladder syndrome score (OABSS), and decreased urinary volume and flow rate, in smokers during the six-month follow-up period after the surgery. No difference in these parameters was recorded before surgery.

Also of note, no significant differences in the International Prostate Symptom Score (IPSS) was found between the two groups.

The researchers concluded that cigarette smoking caused considerable damage to the blood vessels of the prostate, and suggested that smoking has other potentially negative effects on BPH patients, such as extending the duration of prostate surgery and the recovery period from OAB syndrome.