title: Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate.
abstract: OBJECTIVE
  To investigate the incidence of de novo urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia and to determine predictors of postoperative de novo UI.
  
  
  METHODS
  A total of 204 men who underwent HoLEP and in whom 12-month follow-up data on UI were available were included in this study. The efficacy of HoLEP was assessed at 1-, 3-, 6-, and 12-month postoperatively using the International Prostate Symptom Score (IPSS) and with uroflowmetry. The presence or absence of UI was recorded at each follow-up visit. All definitions of UI corresponded to recommendations of the International Continence Society.
  
  
  RESULTS
  The mean preoperative total prostate and transition zone volumes were 53.3 (range 20-162) g and 27.2 (range 4-107) g, respectively. The mean enucleated weight was 23.0 (range 3.0-82.3) g. The IPSS and uroflowmetry showed that all micturition parameters improved significantly starting at 1-month postoperatively. After HoLEP, 29 patients (16.2%) had de novo UI, most of which resolved within 1-6 months; 11 had stress UI, 12 had urgency UI, and the remaining 6 had mixed UI. On logistic regression analysis, bladder mucosal injury during morcellation and maximum urethral closure pressure on baseline urodynamics were the independent predictors of de novo UI after surgery.
  
  
  CONCLUSIONS
  Our data suggest that HoLEP is effective in improving micturition, but de novo postoperative UI occurred in some patients although usually transient. Surgeons should be careful to not injure the bladder mucosa during morcellation.
authors.affiliation: Department of Urology, College of Medicine, Dongguk University, Gyeonggi, Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Cho
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Min Su
authors.initials: MS
authors.lastname: Jeong
authors.forename: Jun-Seok
authors.initials: JS
authors.lastname: Yi
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.forename: Seung-June
authors.initials: SJ
authors.lastname: Oh
authors.forename: Soo Woong
authors.initials: SW
authors.lastname: Kim
authors.forename: Jae-Seung
authors.initials: JS
authors.lastname: Paick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D053844:Lasers, Solid-State / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011470:Prostatic Hyperplasia / Q000601:surgery*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D053202:Urinary Incontinence, Urge / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D014554:Urination; D014563:Urodynamics
chemical_list: D018680:Cholinergic Antagonists