Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach

Enhancing surgical outcomes in HoLEP: A discussion on APUMP and anterior fibromuscular stroma preservation

“…We read with interest the article by Fujisaki et al, 1 examining the anterior prostatic urethral mucosa preservation (APUMP) technique during holmium laser enucleation of the prostate (HoLEP) and its effectiveness in reducing postoperative stress urinary incontinence. The study intriguingly aligns with our own research on anterior fibromuscular stroma (AFS)-preserved enucleation (AFS preserved), 2 where we similarly focus on the preservation of critical anatomical structures to mitigate postoperative complications.…”

“…We hypothesize that damage to the AFS, akin to skeletal muscle injuries, could lead to spasms or hypersensitivity, hence the transient incontinence observed postoperatively. 4 Thus, preserving the AFS not only aligns with maintaining structural integrity but also enhances functional outcomes, mitigating urgency and incontinence by maintaining a more regulated bladder neck and urethral opening.…”

Incidence and predictors of urinary incontinence rates post‐holmium laser enucleation of prostate

“…Recently described surgical enucleation techniques involving early apical release or anterior fibromuscular stroma preservation are proposed to have better stress UI outcomes post-HoLEP. 17,18 In the current study, both obesity and pre-operative UI were predictors of post-HoLEP UI with multivariate analysis at both 6 week and 3 month encounters. Larger specimen weight was another predictor for 6 week UI while higher frailty score was also a predictor for Index (CCI).…”

“…Also, there is a possible effect of attrition bias due to drop‐out of some continent patients with lack of follow up. Recently described surgical enucleation techniques involving early apical release or anterior fibromuscular stroma preservation are proposed to have better stress UI outcomes post‐HoLEP 17,18 …”

Anterior fibromuscular stroma: The possible role for transient incontinence after endoscopic enucleation of prostate

“…In conclusion, the AFS is a muscle unit that plays a significant role in initiating voiding. Identifying and preserving the AFS during transurethral simple prostatectomy is essential for achieving precision enucleation [ 7 ] and avoiding transient postoperative incontinence.…”