Presented by: Jonathan Modai MD
UCLA

Introduction

Transient postoperative urinary incontinence (UI) is a known complication of holmium laser enucleation of prostate (HoLEP). Patients suffering from this complication are reassured about the expected continence recovery but the timeline for this recovery is poorly understood. Studies assessing risk factors for prolonged transient UI found several risk factors, prostate size being one of them. No study to date has evaluated the effect of prostate dimensions on continence recovery after HoLEP. We hypothesize that the torque applied on the external urinary sphincter during HoLEP is influenced by prostate dimensions and affects continence recovery after the procedure.

Materials

We performed a prospective observational cohort study of patients undergoing HoLEP by a single surgeon from 2020 to 2022. Demographic, clinical, and radiographic variables were collected for analysis. Patients were followed post-operatively until they regained urinary continence. Univariate and multivariable logistic regression analyses were performed to identify predictors of early (<1 month) versus delayed (>1 month) continence recovery after HoLEP.

Results

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A total of 244 patients were included in the analysis, 40% of whom took longer than one month to regain continence. Average age, body mass index (BMI), and prostate volume were 70 (44-92), 25 (20.56-32.05), and 120 (18-382), respectively. On univariate analysis, diabetes mellitus, BMI, length of surgery, and weight of resected tissue were all associated with delayed continence recovery. On multivariable analysis, patients with diabetes mellitus (DM) were three times more likely to experience delayed continence recovery (OR 3.02, CI 1.48-6.18). Patients with higher BMI were statistically less likely to experience late continence recovery (OR 0.869, CI 0.76-0.98), but the difference in mean BMI between the groups was only 0.66 and was deemed clinically non-significant. Prostate dimensions were not found to affect continence recovery in neither uni nor multivariate analysis.

Conclusion

Patient-related factors affect post-operative urinary continence recovery after HoLEP. Our findings indicate that DM triples the risk for prolonged incontinence after HoLEP, while prostate dimensions were not found to have such an effect. These findings can help when counseling patients on their expected continence recovery after HoLEP.

Funding

None

Co-Authors

Parth Patel, MD
UCLA

Roi Babaoff, MD
Rabin Medical Center

James Lee,
UCLA

Dong Ho Shin,
UCLA

Kymora Scotland, MD, PHD
UCLA

Matthew Dunn, MD
UCLA