World J Mens Health.  2015 Aug;33(2):88-94. 10.5534/wjmh.2015.33.2.88.

Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate

• Nam JK
• Kim HW
• Lee DH
• Han JY
• Lee JZ
• Park SW

• KMID: 2032828
• DOI: http://doi.org/10.5534/wjmh.2015.33.2.88

Abstract

PURPOSE
To investigate the factors associated with the occurrence of and recovery from transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP).
MATERIALS AND METHODS
From March 2009 to December 2012, 391 consecutive patients treated with HoLEP for benign prostatic hyperplasia were enrolled. Information regarding age, prostate volume, International Prostate Symptom Score, Overactive Bladder Symptom Score, peak urinary flow rate, postvoid residual urine, and operation time was collected. TUI was defined as a patient complaint of urine leakage, regardless of type. Logistic regression was used to investigate the factors associated with the occurrence of TUI, and the Kaplan-Meier test was used to analyze the TUI recovery period.
RESULTS
TUI after HoLEP occurred in 65 patients (16.6%), 52 patients of whom (80.0%) showed recovery within three months. Stress and urge urinary incontinence and postvoid dribbling occurred in 16 patients (4.1%), 29 patients (7.4%), and 33 patients (8.4%), respectively. Age (odds ratio [OR]=3.494; 95% confidence interval [CI]=1.565~7.803; p=0.002) and total operation time (OR=3.849; 95% CI=1.613~9.185; p=0.002) were factors that significantly affected the occurrence of TUI.
CONCLUSIONS
TUI, defined as any type of urine leakage, occurred after HoLEP in some patients, most of whom recovered within three months. Stress urinary incontinence occurred in only 4% of patients after HoLEP. Age and total operation time were associated with the occurrence of postoperative TUI.

Keyword

Lasers; Prostatic hyperplasia; Urinary incontinence

MeSH Terms

Holmium*
Humans
Kaplan-Meier Estimate
Lasers, Solid-State*
Logistic Models
Prostate*
Prostatic Hyperplasia
Risk Factors*
Urinary Bladder, Overactive
Urinary Incontinence*
Holmium

Figure

• 

  Fig. 1 Recovery ratio of transient urinary incontinence depending on its duration. Eighty percent of the patients who complained transient urinary incontinence after holmium laser enucleation of the prostate showed recovery within 3 months from the date of the surgery (n=65).

Reference

1. Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol. 1998; 12:457–459.

2. Kuntz RM, Lehrich K, Ahyai S. Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size. J Endourol. 2004; 18:183–188.

3. Kuntz RM. Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur Urol. 2006; 49:961–969.

4. Shah HN, Mahajan AP, Hegde SS, Bansal MB. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int. 2007; 100:94–101.

5. Lee MH, Yang HJ, Kim DS, Lee CH, Jeon YS. Holmium laser enucleation of the prostate is effective in the treatment of symptomatic benign prostatic hyperplasia of any size including a small prostate. Korean J Urol. 2014; 55:737–741.

6. Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003; 170:1270–1274.

7. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004; 172:1926–1929.

8. Yin L, Teng J, Huang CJ, Zhang X, Xu D. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol. 2013; 27:604–611.

9. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008; 53:160–166.

10. Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of prostate for patients in urinary retention. Urology. 2005; 66:789–793.

11. Gilling PJ, Aho TF, Frampton CM, King CJ, Fraundorfer MR. Holmium laser enucleation of the prostate: results at 6 years. Eur Urol. 2008; 53:744–749.

12. Elzayat EA, Elhilali MM. Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol. 2006; 49:87–91.

13. Hwang JC, Park SM, Lee JB. Holmium laser enucleation of the prostate for benign prostatic hyperplasia: effectiveness, safety, and overcoming of the learning curve. Korean J Urol. 2010; 51:619–624.

14. Seki N, Mochida O, Kinukawa N, Sagiyama K, Naito S. Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. J Urol. 2003; 170:1847–1850.

15. Elmansy HM, Kotb A, Elhilali MM. Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate? J Urol. 2011; 186:1977–1981.

16. Vavassori I, Valenti S, Naspro R, Vismara A, Dell'Acqua V, Manzetti A, et al. Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients. Eur Urol. 2008; 53:599–604.

17. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21:167–178.

18. Lerner LB, Tyson MD, Mendoza PJ. Stress incontinence during the learning curve of holmium laser enucleation of the prostate. J Endourol. 2010; 24:1655–1658.

19. Endo F, Shiga Y, Minagawa S, Iwabuchi T, Fujisaki A, Yashi M, et al. Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence. Urology. 2010; 76:1451–1455.

20. Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010; 57:179–192.

21. Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010; 183:1105–1109.

22. Baazeem AS, Elmansy HM, Elhilali MM. Holmium laser enucleation of the prostate: modified technical aspects. BJU Int. 2010; 105:584–585.

23. Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F, et al. A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009; 55:1345–1357.

24. Lerner LB, Tyson MD. Holmium laser applications of the prostate. Urol Clin North Am. 2009; 36:485–495.

25. Placer J, Gelabert-Mas A, Vallmanya F, Manresa JM, Menéndez V, Cortadellas R, et al. Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. Urology. 2009; 73:1042–1048.

26. Porru D, Campus G, Caria A, Madeddu G, Cucchi A, Rovereto B, et al. Impact of early pelvic floor rehabilitation after transurethral resection of the prostate. Neurourol Urodyn. 2001; 20:53–59.