Comparison of different en bloc HoLEP techniques to reduce the rate of postoperative transient urinary incontinence
Chung-Yu Lin1, Chun-Hsuan Lin1, Wen-Jeng Wu1, Ching-Chia Lee1, Hung-Long Ko1, Sheng-Chen Wen1
Department of Urology1, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Purpose: To investigate postoperative factors in transient urinary incontinence (TUI) after different en bloc holmium laser enucleation of the prostate (HoLEP) techniques and use of 3 horseshoe-shaped incisions.
Materials and Methods: Between January 2017 and October 2019, 169 consecutive patients underwent different HoLEP techniques using original en bloc, en bloc with early mucosal strip detachment, and 3 horseshoe-shaped incisions to treat bladder outlet obstruction. Preoperative variables and surgical quality indexes between groups were recorded. TUI was defined as any hygienic or social problem caused by involuntary loss of urine at 2 weeks postoperatively. Postvoid residual urine (PVR), maximum urinary flow rate (Q max), and International Prostate Symptom Score (IPSS) were assessed
Results: Compared with the original en bloc and en bloc with early mucosal strip detachment techniques, patients in the 3 horseshoe-shaped incision group had a statistically significant decrease in TUI (3.5% vs 9.7% and 14%, respectively; p = 0.001) and IPSS score (p = 0.031). Although not statistically significant, the 3 horseshoe-shaped incisions group showed a trend toward a faster enucleation time (p = 0.051). No life-threatening intraoperative complications were recorded among the 3 groups.
Conclusions: Use of 3 horseshoe-shaped incisions in an en bloc HoLEP technique was shown to prevent urethral sphincter damage with a low rate of postoperative TUI. Further comparative assessment of long-term data in a multicenter trial is required.