Asian Journal of Andrology (May 2024)

Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques: a multicenter, real-world experience of 5068 patients

  • Daniele Castellani,
  • Vineet Gauhar,
  • Khi Yung Fong,
  • Mario Sofer,
  • Moisés Rodríguez Socarrás,
  • Azimdjon N Tursunkulov,
  • Lie Kwok Ying,
  • Sarvajit Biligere,
  • Ho Yee Tiong,
  • Dean Elterman,
  • Abhay Mahajan,
  • Mark Taratkin,
  • Sorokin Nikolai Ivanovich,
  • Tanuj Pal Bhatia,
  • Dmitry Enikeev,
  • Nariman Gadzhiev,
  • Mohammed Taif Bendigeri,
  • Jeremy Yuen-Chun Teoh,
  • Marco Dellabella,
  • Fernando Gómez Sancha,
  • Bhaskar Kumar Somani,
  • Thomas Reinhard William Herrmann

DOI
https://doi.org/10.4103/aja202375
Journal volume & issue
Vol. 26, no. 3
pp. 233 – 238

Abstract

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We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62–73] years vs 69 [63–74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52–92] ml in Group 1 vs 70 [54–90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

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