Factors associated with urinary incontinence after endoscopic prostate enucleation: A scoping review

Endoscopic enucleation of the prostate is an established treatment for benign prostatic obstruction, providing substantial improvement in lower urinary tract symptoms and urinary flow. However, postoperative urinary incontinence (UI), typically transient, remains a relevant concern. Evidence regarding factors associated with postoperative UI remains heterogeneous. This scoping review aimed to synthesize available literature describing variables associated with urinary incontinence following endoscopic prostate enucleation.

A scoping review was conducted using PubMed and Embase. The search identified 490 records; after duplicate removal and screening by three independent reviewers, 52 studies were included. Most were retrospective cohort studies with heterogeneous designs, follow-up intervals, and definitions of UI. Data analyzed descriptively in accordance with PRISMA-ScR guidelines.

Reporting of postoperative UI varied across studies, including differences in subtype classification and outcome measurement methods. Early postoperative UI was commonly reported (15-35%), with most cases resolving within 6 months and persistent incontinence generally below 3% at one year. Advanced age, diabetes mellitus, obesity, larger prostate volume, greater resected tissue weight, and elevated preoperative post-void residual were described as associated with early UI. However, variability in outcome definitions and inconsistent multivariable adjustment limited identification of definitive independent predictors.

Postoperative urinary incontinence after endoscopic prostate enucleation is transient and resolves over time. Although several patient and surgical factors are repeatedly linked to early UI, heterogeneity of existing evidence precludes firm conclusions regarding independent predictors. Standardized outcome definitions and prospective studies are needed to improve risk stratification and guide perioperative counseling.