title: Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate?
abstract: OBJECTIVE
  In this study we defined high risk patients at high risk of stress urinary incontinence after holmium laser enucleation of the prostate.
  
  
  METHODS
  We performed a retrospective analysis during a 10-year period of 949 consecutive patients treated with holmium laser enucleation of the prostate by a single surgeon. Patients were divided into group 1--those without postoperative stress urinary incontinence (902) and group 2--those with stress urinary incontinence (47). All preoperative, intraoperative and postoperative clinical variables were compared between the 2 groups.
  
  
  RESULTS
  Patient age, preoperative and postoperative prostate specific antigen, preoperative medications, preoperative acute retention and duration of postoperative catheter time were not associated with postoperative stress urinary incontinence. The presence of diabetes mellitus was significantly associated with a higher incidence of stress urinary incontinence (p <0.001). Using medians of the whole cohort, prostate volume greater than 81 gm, operative time greater than 96 minutes and reduction in prostate specific antigen greater than 84% were significantly associated with stress urinary incontinence. On multivariate analysis prostate volume greater than 81 gm, the presence of diabetes mellitus and greater than 84% reduction in prostate specific antigen remained statistically significant.
  
  
  CONCLUSIONS
  Holmium laser enucleation of the prostate results in stress urinary incontinence at a rate comparable to that of other surgical techniques for the treatment of benign prostatic hyperplasia. The presence of diabetes mellitus, large prostate volume and a greater reduction in postoperative prostate specific antigen remained statistically significant for the development of stress urinary incontinence. Patients with diabetes, especially those with a large prostate, should be encouraged to start Kegel exercises in the immediate postoperative period.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Elmansy
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kotb
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Elhilali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods*; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*; D016055:Urinary Retention / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen