Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence

The prevalence of transient stress urinary incontinence (SUI) after HoLEP has been reported to be as high as 44%. Anteroposterior dissection HoLEP was newly developed to protect the urethral sphincter and therefore lower the incidence rate of SUI. This study was conducted to determine the SUI incidence rate after anteroposterior dissection HoLEP.

Sixty-eight consecutive patients with benign prostatic hyperplasia underwent HoLEP from January to December 2008. The first 31 cases (Surgery 1) underwent HoLEP according to Gilling's method. The next 37 cases (Surgery 2) underwent anteroposterior dissection HoLEP, where adenoma was dissected antegradely. This antegrade movement of the cystoscope allows the apical gland to be removed from the sphincter without causing damage. Surgical quality indexes (hemoglobin change, operating time, resected prostate volume) between the 2 groups were compared. All patients were assessed at 2 weeks postoperatively for clinical SUI, international prostate symptom score (IPSS), quality of life (QoL), and peak flow rates (Q(max)).

Patient characteristics and surgical quality indexes did not differ between the 2 groups. Clinical SUI was found in 25.2% of cases in the Surgery 1 group, but only 2.7% in the Surgery 2 group. IPSS, QoL and Q(max.) were significantly improved postoperatively in both groups. At 2 weeks, the QoL of the Surgery 2 group was significantly improved compared with that observed for Surgery 1 (1.5 ± 1.1 vs 2.4 ± 1.0, P = .02). The Q(max.) of Surgery 2 was significantly higher compared with Surgery 1 (19.8 ± 8.4 vs 13.0 ± 4.7 ml/s, P = .02).

These results indicate that our anteroposterior dissection HoLEP is a promising procedure to avoid postoperative SUI and also to substantially improve QoL.