Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate

Abstract

Aims: To investigate the incidence of de novo urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia and to determine predictors of postoperative de novo UI.

Methods: A total of 204 men who underwent HoLEP and in whom 12-month follow-up data on UI were available were included in this study. The efficacy of HoLEP was assessed at 1-, 3-, 6-, and 12-month postoperatively using the International Prostate Symptom Score (IPSS) and with uroflowmetry. The presence or absence of UI was recorded at each follow-up visit. All definitions of UI corresponded to recommendations of the International Continence Society.

Results: The mean preoperative total prostate and transition zone volumes were 53.3 (range 20-162) g and 27.2 (range 4-107) g, respectively. The mean enucleated weight was 23.0 (range 3.0-82.3) g. The IPSS and uroflowmetry showed that all micturition parameters improved significantly starting at 1-month postoperatively. After HoLEP, 29 patients (16.2%) had de novo UI, most of which resolved within 1-6 months; 11 had stress UI, 12 had urgency UI, and the remaining 6 had mixed UI. On logistic regression analysis, bladder mucosal injury during morcellation and maximum urethral closure pressure on baseline urodynamics were the independent predictors of de novo UI after surgery.

Conclusions: Our data suggest that HoLEP is effective in improving micturition, but de novo postoperative UI occurred in some patients although usually transient. Surgeons should be careful to not injure the bladder mucosa during morcellation.