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

Abstract

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.

A Prospective, Randomized Clinical Trial Comparing Plasmakinetic Resection of the Prostate with Holmium Laser Enucleation of the Prostate Based on a 2-Year Followup

“…Thus, surgeons should be careful not to injure the bladder mucosa during morcellation. 26 As previously mentioned by Fayad et al, we did identify some disadvantages of HoLEP compared to PKRP. 10 The operation time required is longer for HoLEP than for PKRP.…”

Practical Index of Urinary Incontinence Following Holmium Laser Enucleation of the Prostate: A Case-Series Study of the 24-Hour Pad Test Immediately after Catheter Removal

“…Indeed, a previous study defined the postoperative mixed UI and use of a pad as SUI [13]. However, another report described the development of not only de novo SUI, but also de novo UUI after HoLEP [14]. In this study, we defined postoperative UI as that reported by a patient, which included any UI such as SUI, UUI, and dribbling after urination.…”

“…In previous studies, the patient factors associated with post-HoLEP UI included the (predicted) enucleated tissue weight, DM, and a high PSA reduction rate [12]; the medical factors included the operator's surgical proficiency level [13] and bladder mucosal injury [14] at the time of surgery. However, no consensus has been reached regarding these factors.…”

“…Continued UI after prostate surgery has been reported to deteriorate a patient's health-related quality of life (QOL), as measured by instruments such as the EuroQOL-5 Dimension and Short Form 12-Item Survey [11]; accordingly, UI after HoLEP is thought to similarly influence the health-related QOL. Some reports have described the preoperative prognosticators of post-HoLEP UI [12,13,14] and have devised procedures to prevent this complication [15]. However, it is challenging to address this issue because many patients are poorly compliant after surgery (i.e., do not regularly visit hospitals); additionally, no sufficient evaluation method has been established because of the lack of a clear and unified standard, in contrast to the post-surgical follow-up procedures for cases involving malignant diseases such as prostate cancer.…”

Thulium Laser Enucleation Versus Plasmakinetic Enucleation of the Prostate: A Randomized Trial of a Single Center

“…20 There is a higher risk of a harmful effect to the external sphincter while making the 12 o'clock incision because there is no landmark such as the verumontanum. 21 For safety, we usually left some apical tissue to avoid stress urinary incontinence that might occur from the injury to the external sphincter. This might explain that there was one patient in each of the two groups who showed residual tissue at the apex of prostatic fossa.…”