Age and prostate volume are risk factors for transient urinary incontinence after transurethral enucleation with bipolar for benign prostatic hyperplasia

Abstract

Objectives: To investigate the predictive factors for transient urinary incontinence after transurethral enucleation with bipolar. Methods: We retrospectively analyzed the data of 584 patients who underwent transurethral enucleation with bipolar between December 2011 and September 2016 operated by a single surgeon. Urinary incontinence after transurethral enucleation with bipolar was defined as involuntary leakage of urine that required the use of pads. It was evaluated at 1 week, and 1, 3, 6, 12 and 24 months after transurethral enucleation with bipolar. We defined transient urinary incontinence as urinary incontinence persisting up to 1 month after transurethral enucleation with bipolar. Based on independent risk factors identified by a multivariate stepwise logistic regression analysis, a nomogram to predict transient urinary incontinence was developed. Results: Of the 584 patients, 17.3%, 13.5%, 3.1%, 0.41%, and 0% patients had urinary incontinence at 1 week, 1, 3, 6 and 12 months after transurethral enucleation with bipolar, respectively. The mean (AEstandard error) age was 69.6 AE 0.26 years, estimated prostate volume was 54.7 AE 0.91 cm 3 , operative time was 58.0 AE 1.1 min and the prostate specimen weight was 30.6 AE 0.69 g. On univariate analysis, age, prostate volume estimated by transrectal ultrasonography, prostate-specific antigen, prostate specimen weight, operative time, prostate specimen weight/prostate volume and prostate specimen weight/operative time were significant predictive factors for transient urinary incontinence after transurethral enucleation with bipolar. On multivariate analysis, age (hazard ratio 1.07, P-value = 0.0034) and prostate volume (hazard ratio 1.03, P-value < 0.0001) were independent risk factors for transient urinary incontinence after transurethral enucleation with bipolar. Conclusions: Age and prostate volume estimated by transrectal ultrasonography seem to represent significant independent risk factors for transient urinary incontinence after transurethral enucleation with bipolar. This should be well discussed with the patient before surgery.

Is the membranous urethral length related to postoperative urinary incontinence after holmium laser enucleation of the prostate?

“…investigated the relationship between PV and the incidence of stress urinary incontinence after HoLEP, and discovered that large prostate size is associated with longer operative time and longer time of manipulation with the sheath across the external sphincter during HoLEP 12 . Other previous reports suggested that the damage to the urethral sphincter as a result of prolonged operation times was one of the causes of postoperative TUI; they emphasized the importance of reducing operation times 13,15,22 . The present results were consistent with their reported findings.…”

Impact on Sexual Function of Endoscopic Enucleation vs Transurethral Resection of the Prostate for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

“…35 The majority of PKEP is performed bluntly using the tip of the resectoscope or electrode, 10 and this mechanical dissection will stretch the inner longitudinal layer around the apex of prostate, and might result in transient injury to the urethral sphincter complex and surrounding structures. 36 Considering that the neurovascular bundle runs only 3 mm from the apical prostate capsule, and 3 to 4 mm from the membranous urethral lumen, 37 further studies are needed to comprehensively evaluate the potential impact of mechanical enucleation on EF.…”

Complications of anatomical endoscopic enucleation of the prostate

“…Although UI is defined differently in different literature which is one of the limitations when comparing UI, most study defined UI after AEEP as involuntary leakage of urine that required the use of pads (Hirasawa, Kato, & Fujita, ). There were several causes of UI, including dysfunction of the bladder and urethra, intra‐operative injury to the external sphincter of the urethra, prolonged retention catheterisation, local infection or oedema of the prostatic fossa and urethra (Hirasawa et al, ; Nojavan et al, ; Sapetti et al, ). Different types of post‐operative UI could occur in patients with BPO, including transient UI, permanent UI, stress UI, urgency UI, mixed UI and so on.…”

“…It is reported that the incidence of post‐operative UI could be reduced significantly after 20–30 cases under the guidance of experienced surgeon; however, at least 50 cases are required in the absence of guidance, and even with the experience of more than 80 cases, there were 25% of patients developing incontinence (Endo et al, ). In addition, older age, larger prostate volume, longer operative time and intra‐operative blood loss were also predictors of UI after AEEP (Hirasawa et al, ; Rausch et al, ; Xu et al, ).…”