Anterior Fibromuscular Stroma-Preserving Anteroposterior Dissection HoLEP Reduces Day-1 Incontinence: A Retrospective...

Area of Science:

• Urology
• Surgical Innovation
• Postoperative Recovery

Background:

• Benign prostatic hyperplasia (BPH) management often involves Holmium Laser Enucleation of the Prostate (HoLEP).
• Urinary incontinence is a common concern following HoLEP procedures.
• Optimizing surgical techniques to minimize postoperative incontinence is crucial for patient quality of life.

Purpose of the Study:

• To evaluate the impact of anterior fibromuscular stroma (AFS) preservation on ultra-early postoperative incontinence after anteroposterior (AP) HoLEP.
• To determine if AFS preservation is an independent predictor of reduced Day-1 incontinence.
• To assess the safety profile of AFS-preserving AP-HoLEP.

Main Methods:

• Retrospective analysis of 272 consecutive AP-HoLEP cases performed by a single surgeon.
• Classification of cases into conventional AP-HoLEP (CON), mucosal incision-first AP-HoLEP (MI), and AFS-preserving AP-HoLEP (AFS).
• Primary endpoint: Day-1 incontinence (any leakage within 24 hours of catheter removal). Multivariable logistic regression analysis was employed.

Main Results:

• Day-1 incontinence rates were 55% (CON), 58% (MI), and 25% (AFS) (p=0.003).
• AFS preservation was independently associated with significantly lower odds of Day-1 incontinence compared to CON (OR, 0.30; p=0.016).
• Perioperative safety outcomes were comparable across groups, with low rates of severe complications.

Conclusions:

• AFS preservation within an AP-HoLEP platform is associated with improved Day-1 continence.
• Ventral-support preservation through AFS preservation is a key factor for rapid continence recovery.
• The AFS-preserving technique offers enhanced early functional outcomes without compromising surgical safety.