Smooth muscle contractility of laser-enucleated prostate tissues and impacts of preoperative α1-blocker treatment in patients with and without catheterization

Prostate smooth muscle contraction is central in treatment of voiding symptoms in benign prostatic hyperplasia (BPH). Tissues from transurethral resection of the prostate (TURP) and radical prostatectomy (RP) for prostate cancer are widely used to study contractions. However, findings are limited by traumatization in TURP, and uncertain relationship to BPH in RP tissues. This study aims to examine contractions of laser-enucleated tissues. Tissues from holmium/thulium laser enucleation (HoLEP/ThuLEP) and TURP were contracted by KCl, noradrenaline and electric field stimulation (EFS) in an organ bath. Contractions were compared to RP tissues in previous studies. KCl-induced contractions averaged 2.5 mN, 0.7 mN and 3.3 mN in tissues from HoLEP/ThuLEP, TURP and RP, with non-responsive tissues included (2.4% HoLEP/ThuLEP, 37% TURP). Maximum EFS-induced contractions (E_max) averaged 47% of KCl in HoLEP/ThuLEP tissues, 27% in TURP tissues, and 68-235% in 21 previous studies with RP tissues. E_max values for noradrenaline averaged 99.7% in HoLEP/ThuLEP tissues, 56% in TURP tissues, and ranged from 92 to 260% in RP tissues. Preoperative α₁-blocker treatment reduced EFS- and noradrenaline-induced contractions, and increased EC₅₀ values for noradrenaline in laser-enucleated, catheterized patients, but not in patients without catheterization. Also, the ex vivo application of α₁-blockers increased the EC₅₀ values for noradrenaline and reduced E_max for EFS. Laser-enucleated tissues allow investigation of prostate smooth muscle contraction in medication-refractory voiding symptoms. Different impacts of preoperative α₁-blocker treatment on ex vivo contractility in tissues from patients with and without catheterization point to clinically relevant heterogeneity of patients undergoing surgery for BPH.