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Predictive factors of urinary incontinence after holmium laser enucleation of the prostate: a multicentric evaluation

  • Vianney Houssin 1,
  • Jonathan Olivier 1,
  • Martin Brenier 1,
  • Adeline Pierache 2,
  • Marc Laniado 3,
  • Martin Mouton 4,
  • Pierre Etienne Theveniaud 4,
  • Hervé Baumert 4,
  • Richard Mallet 5,
  • Thibault Marquette 6,
  • Arnauld Villers 1,
  • Grégoire Robert 6,
  • Jerome Rizk 1
1 Department of Urology, Hôpital Claude Huriez, University of Lille, Rue Michel Polonowski, 59037, Lille, France 2 Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des Technologies de santé et des pratiques médicales, 59000, Lille, France 3 The Prostate Unit, BUPA Cromwell Hospital, London, UK 4 Department of Urology, Paris Saint-Joseph Hospital, Paris, France 5 Department of Urology, Clinique des Cèdres, Brive la Gaillarde, France 6 Department of Urology, University of Bordeaux, Bordeaux, France

Publication: World Journal of Urology, March 2020

Objective

To evaluate predictive factors of urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP).

Methods

Patients (n = 2346) were included in a retrospective multicentric study from April 2012 to November 2017. Patients’ characteristics (age, BMI, percentage with diabetes), preoperative data (IPSS score, whole gland volume, urinary drainage), operative data (enucleation time, enucleation efficiency, tissue enucleated weight, total delivered energy) and postoperative data were recorded. Absence of UI was defined as no pads at 3 and 6 months. Surgeon experience was stratified in three categories: beginners (< 21 cases), intermediate (21–40 cases) and experienced (> 40 cases). Multivariate logistic regression analysis was performed.

Results

UI was observed in 14.5% of patients (340/2346) at 3 months (95%CI 13–16%) and in 4.2% (98/2346) at 6 months (95%CI 3–5%). On multivariate analysis at 3 months, increasing age (OR per SD = 1.3 [1.14–1.48]), elevated BMI (OR per SD = 1.23 [1.09–1.38]), preoperative urinary drainage (OR = 0.62 [0.45–0.85]), increasing enucleated tissue weight (OR per SD = 1.29 [1.16–1.45]) and experienced surgeon with at least 40 cases (OR = 0.56 [0.42–0.75]) were significantly associated with UI. At 6 months, increasing age (OR per SD = 1.25 [1.01–1.53]), elevated BMI (OR per SD = 1.25 [1.03–1.5]), increasing whole gland volume (OR per one SD log = 1.24 [1.01–1.53]) and diabetes disorder (OR = 1.7 [1.03–2.78]) were significantly associated with UI.

Conclusion

UI after HoLEP was observed in 14.5% of patients at 3 months and 4.2% at 6 months, with stress UI in half of the cases. Surgeon experience with at least 40 cases was the main predictive factor of 3 months UI after HoLEP and diabetes disorder of persistent UI at 6 months.