[Postoperative stress urinary incontinence in patients after various techniques of laser enucleation for benign...

To compare the incidence of postoperative stress urinary incontinence (SUI) in patients with benign prostatic hyperplasia after three different techniques of thulium fiber laser prostate enucleation (ThuFLEP): two-lobe, enucleation of all lobes in a single block (en-bloc) and enucleation of all lobes in a single block without additional longitudinal incisions (total en-bloc).

A retrospective and prospective comparative analysis included 472 patients, who were undergone to three different techniques of ThuFLEP. The surgical interventions were performed by three experienced surgeons from January 2015 to May 2023. The incidence of postoperative stress urinary incontinence (SUI), risk factors for SUI, and the rate of improvement in patients with SUI were evaluated. The patients were examined pre- and postoperatively.

Logistic regression analysis was used to assess the effect of two main predictors, surgical technique and prostate volume, on the SUI after the surgical procedure. The postoperative SUI developed in 49 (10.4%) patients. After 6 months, SUI persisted in only 6 (1,3%) cases. Uni- and multivariate analysis of these predictors was performed. Depending on the technique of laser enucleation, the incidence of SUI reached 13.9% after the two-lobe technique, 12.4% after the en-bloc technique, and 5.4% after the total en-bloc technique. In addition, the total en-bloc technique proved an earlier restoration of urinary continence after laser enucleation. Uni- and multivariate analysis showed the significant influence of the surgical technique on the SUI (p=0.013 for the univariate analysis, p=0.046 for the multivariate analysis).

We confirmed the significant reduction of the postoperative SUI in the first six months when used the total en-bloc technique with additional beneficial effect on early recovery of urinary continence.