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

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Abstract

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.

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Abbreviations

BPH:

Benign prostatic hyperplasia

BPO:

Benign prostatic obstruction

CI:

Confidence interval

EEP:

Endoscopic enucleation of the prostate

HoLEP:

Holmium laser enucleation of prostate

IPSS:

International Prostate Symptom Score

MUI:

Mixed urinary incontinence

OR:

Odds ratio

PSA:

Prostate-specific antigen

SD:

Standard deviation

SUI:

Stress urinary incontinence

TURP:

Transurethral resection of the prostate

UUI:

Urge urinary incontinence

UI:

Urinary incontinence

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Authors and Affiliations

  1. Department of Urology, Hôpital Claude Huriez, University of Lille, Rue Michel Polonowski, 59037, Lille, France

    Vianney Houssin, Jonathan Olivier, Martin Brenier, Arnauld Villers & Jerome Rizk

  2. Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des Technologies de santé et des pratiques médicales, 59000, Lille, France

    Adeline Pierache

  3. The Prostate Unit, BUPA Cromwell Hospital, London, UK

    Marc Laniado

  4. Department of Urology, Paris Saint-Joseph Hospital, Paris, France

    Martin Mouton, Pierre Etienne Theveniaud & Hervé Baumert

  5. Department of Urology, Clinique des Cèdres, Brive la Gaillarde, France

    Richard Mallet

  6. Department of Urology, University of Bordeaux, Bordeaux, France

    Thibault Marquette & Grégoire Robert

Authors
  1. Vianney Houssin
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  2. Jonathan Olivier
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  3. Martin Brenier
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  4. Adeline Pierache
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  6. Martin Mouton
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  8. Hervé Baumert
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  9. Richard Mallet
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  11. Arnauld Villers
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  12. Grégoire Robert
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  13. Jerome Rizk
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Contributions

VH: project development and manuscript writing; JO, ML: manuscript writing; MB: data collection; AP: data analysis; MM, PET, HB, RM and TM: data collection or management; AV, GR and JR: project development and manuscript writing.

Corresponding author

Correspondence to Jonathan Olivier.

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Conflict of interest

V. Houssin, J. Olivier, M. Brenier, A. Pierache, M. Laniado, M. Mouton, T. Marquette, A.Villers declare that they have no conflict of interest. PE. Theveniaud, H. Baumert, R. Mallet, G. Robert, J. Rizk: HOLEP proctor for EDAP/TMS.

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Houssin, V., Olivier, J., Brenier, M. et al. Predictive factors of urinary incontinence after holmium laser enucleation of the prostate: a multicentric evaluation. World J Urol 39, 143–148 (2021). https://doi.org/10.1007/s00345-020-03169-0

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  • DOI: https://doi.org/10.1007/s00345-020-03169-0

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