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

Ueki, Hideto; Takahashi, Kosuke; Yasufuku, Tomihiko; Yuen, Keiji; Yamashita, Masuo

doi:10.1111/iju.14322

Cited by 10 publications

(3 citation statements)

References 24 publications

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“…In the widest randomized controlled trial to date, Thomas et al have [8] reported a 7% rate of incontinence in the first 6 months after Greenlight photovaporisation of the prostate. Regarding holmium laser enucleation of the prostate (HoLEP0, the most widely used EEP technique actually used, several predictive factors have been reported [9 ▪ ,10]: membranous urethral length on preoperative magnetic resonance imaging, patient age, elevated body mass index, operative time/prostate size, experience of the surgeon. To date, most of cases of transient incontinence lead to conservative management, including physiotherapy.…”

Section: Epidemiologymentioning

confidence: 99%

State of the art on stress incontinence management after benign prostatic obstruction surgery

Sabbagh

Dupuis

Cornu

2021

Current Opinion in Urology

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Purpose of review Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation. Recent findings Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience. Summary The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.

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Section: Epidemiologymentioning

confidence: 99%

State of the art on stress incontinence management after benign prostatic obstruction surgery

Sabbagh

Dupuis

Cornu

2021

Current Opinion in Urology

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“…TUI is one of the most disturbing side effects of this surgical technique because a substantial portion of patients recover on their own in 90 days on average, but occasionally it reduces the subject's quality of life. Despite the fact that HoLEP has some benefits, surgeons may strive to avoid it for the aforementioned reasons [2,8].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Early Post-Operative Transient Urinary Incontinence After Holmium Laser Enucleation of Prostate

TRIPATHI¹,

DIXIT²

2022

Asian J Pharm Clin Res

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Objective: Despite having various benefits, post-operative transient urine incontinence (TUI) is a significant consequence of holmium laser prostate enucleation (HoLEP) in a small percentage of patients. To manage benign prostatic hypertrophy, it is critical to establish predictive risk factors of early postoperative TUI after HoLEP. Methods: One hundred participants participated in this hospital-based study over the course of 15 months in a tertiary care facility in Mohali and Punjab. All indoor benign prostatic hyperplasia patients who underwent HoLEP treatment from a single surgeon and were monitored for at least 3 months after the procedure made up the study population. Clinical information that was deemed pertinent was recorded. Results: The study’s participants had an average age of 68.54 +/− 7.72 years. Patients who had experienced acute urine retention made up 48% of the population. Mean prostate size and mean International Prostate Symptom Score (IPSS) were 64.19 ml and 28.35 ml, respectively, preoperatively. Diabetes mellitus, prostate volume (>58 cc), overall operation time (>131 min), enucleated prostate volume (42 g), total energy used (>154 kJ), and percentage decrease in prostate-specific antigen (60%) were all substantially linked to post-operative TUI. Total energy was found to be a predictor for post-operative TUI in multivariate analysis. Conclusion: The following factors were discovered to be statistically linked with postoperative TUI: Diabetes mellitus, prostate volume (>58 cc), total operation time (>131 min), enucleated prostate volume (42 g), total energy used (>154 kJ), and reduction in Prostate Specific Antigen (60%) Multivariate research revealed that the only independent predictor for post-operative TUI was total energy consumed.

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“…Therefore, TUL should be evaluated within 3 months after surgery. Studies have reported that many variables such as surgeon experience, diabetes mellitus, body mass index (BMI), prostate volume, operation time, and membranous urethra length are risk factors for TUL 6,7 . However, during the surgery, the external urethral sphincter (EUS) can be damaged by manipulation of the resectoscope sheath, which may lead to TUL.…”

Section: Introductionmentioning

confidence: 99%

Does the use of a small‐size resectoscope during enucleation prevent transient urinary leakage and urethral stricture following holmium laser enucleation of the prostate?

İbiş

Tokatlı

2021

LUTS

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Objective To investigate the effect of the use of a small‐size resectoscope for enucleation during holmium laser enucleation of the prostate (HoLEP) on the prevention of transient urinary leakage (TUL) and urethral stricture (US). Methods One hundred patients were included in a retrospective single‐center study from January 2019 to December 2020. The patients were divided into two groups according to the resectoscope size which was used for enucleation (22F in group A [n = 40] and 26F in group B [n = 60]). Patients were evaluated at 4, 12, and 24 weeks postoperatively for TUL and US. Univariate and multivariate regression analyses were implemented to assess the variables which are associated with TUL at 4 weeks. Results Baseline characteristics and perioperative data were observed to be well balanced between groups. A statistically significant higher occurrence of TUL was detected at 4 weeks in group B compared to group A (P = .018). Higher improvement in International Prostate Symptom Score (IPSS) and quality of life (QoL) was observed in group A at 4 and 12 weeks postoperatively. On univariate analysis, resectoscope size, specimen weight, and body mass index were significant predictive factors for TUL at 4 weeks. Multivariate analysis illustrated that the resectoscope size was independently associated with TUL at 4 weeks after HoLEP (odds ratio = 3.1 [1.02‐9.38]). One patient in group A (2.5%) and two patients in group B (5%) demonstrated US (P = .648). Conclusion Enucleation with a 22F resectoscope provides better QoL and IPSS by reducing TUL rates in the early postoperative period.

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

Cited by 10 publications

References 24 publications

State of the art on stress incontinence management after benign prostatic obstruction surgery

State of the art on stress incontinence management after benign prostatic obstruction surgery

Predictors of Early Post-Operative Transient Urinary Incontinence After Holmium Laser Enucleation of Prostate

Does the use of a small‐size resectoscope during enucleation prevent transient urinary leakage and urethral stricture following holmium laser enucleation of the prostate?

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