Abstract

Objective

To evaluate predictive factors of urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP).

Methods

Patients (n = 2346) were included in a retrospective multicentric study from April 2012 to November 2017. Patients’ characteristics (age, BMI, percentage with diabetes), preoperative data (IPSS score, whole gland volume, urinary drainage), operative data (enucleation time, enucleation efficiency, tissue enucleated weight, total delivered energy) and postoperative data were recorded. Absence of UI was defined as no pads at 3 and 6 months. Surgeon experience was stratified in three categories: beginners (< 21 cases), intermediate (21–40 cases) and experienced (> 40 cases). Multivariate logistic regression analysis was performed.

Results

UI was observed in 14.5% of patients (340/2346) at 3 months (95%CI 13–16%) and in 4.2% (98/2346) at 6 months (95%CI 3–5%). On multivariate analysis at 3 months, increasing age (OR per SD = 1.3 [1.14–1.48]), elevated BMI (OR per SD = 1.23 [1.09–1.38]), preoperative urinary drainage (OR = 0.62 [0.45–0.85]), increasing enucleated tissue weight (OR per SD = 1.29 [1.16–1.45]) and experienced surgeon with at least 40 cases (OR = 0.56 [0.42–0.75]) were significantly associated with UI. At 6 months, increasing age (OR per SD = 1.25 [1.01–1.53]), elevated BMI (OR per SD = 1.25 [1.03–1.5]), increasing whole gland volume (OR per one SD log = 1.24 [1.01–1.53]) and diabetes disorder (OR = 1.7 [1.03–2.78]) were significantly associated with UI.

Conclusion

UI after HoLEP was observed in 14.5% of patients at 3 months and 4.2% at 6 months, with stress UI in half of the cases. Surgeon experience with at least 40 cases was the main predictive factor of 3 months UI after HoLEP and diabetes disorder of persistent UI at 6 months.

中文翻译：

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钬激光前列腺摘除术后尿失禁的预测因素：多中心评估

摘要

客观的

评估钬激光前列腺摘除术 (HoLEP) 后尿失禁 (UI) 的预测因素。

方法

 2012 年 4 月至 2017 年 11 月，患者（n = 2346）被纳入一项回顾性多中心研究。记录摘除时间、摘除效率、组织摘除重量、总输送能量）和术后数据。没有 UI 被定义为在 3 个月和 6 个月时没有垫。外科医生的经验分为三类：初学者（< 21 例）、中级（21-40 例）和有经验的（> 40 例）。进行多变量逻辑回归分析。

结果

3 个月时 14.5% (340/2346) 的患者 (95%CI 13-16%) 和 4.2% (98/2346) 6 个月时 (95%CI 3-5%) 观察到 UI。在 3 个月时的多变量分析中，年龄增加（OR = 1.3 [1.14-1.48]），BMI 升高（OR / SD = 1.23 [1.09-1.38]），术前排尿（OR = 0.62 [0.45-0.85]） ，增加去核组织重量（每 SD 的 OR = 1.29 [1.16-1.45]）和至少 40 例经验丰富的外科医生（OR = 0.56 [0.42-0.75]）与 UI 显着相关。在 6 个月时，年龄增加（每个 SD 的 OR = 1.25 [1.01-1.53​​]），BMI 升高（每个 SD 的 OR = 1.25 [1.03-1.5]），增加整个腺体体积（每个 SD log 的 OR = 1.24 [1.01-1.53​​] ]) 和糖尿病疾病 (OR = 1.7 [1.03–2.78]) 与 UI 显着相关。

结论

HoLEP 后的 UI 在 3 个月时观察到 14.5% 的患者和 6 个月时的 4.2%，其中一半的病例出现压力 UI。至少40例的外科医生经验是HoLEP后3个月UI和6个月持续UI糖尿病的主要预测因素。