Incidence and predictors of urinary incontinence rates after thulium fiber laser enucleation of prostate performed by single surgeon

Figures & data

Table 1. Type of incontinence in three different periods.

	Overall n = 109	Duration of urinary incontinence
		< 1 months n = 46	1 to 3 months n = 57	> 3 months n = 6
Incontinence rate, n, (%)	109 (28.6%)	46 (12.1%)	57 (14.9%)	6 (1.6%)
Incontinence type, n, (%)
Stress UI	44 (11.5%)	20 (5.2%)	21 (5.5%)	3 (0.8%)
Urge UI	45 (11.8%)	18 (4.7%)	26 (6.8%)	1 (0.3%)
Mixed UI	20 (5.2%)	8 (2.1%)	10 (2.6%)	2 (0.5%)
Kegel exercises, n, (%)	79 (72.5%)	39 (84.8%)	35 (62.5%)	5 (100.0%)

Table 2. Preoperative and intraoperative patient characteristics.

Parameters	Whole cohort (n=381)	Continent (n=272)	Incontinence (n=109)	р
Age, years, median (IQR)	67.0 (61.0–72.0)	67.0 (61.0–73.0)	67.0 (63.0–72.0)	0.240
ASA, score				0.745
1, n, (%)	24 (6.3%)	20 (7.4%)	4 (3.7%)
2, n, (%)	313 (82.2%)	221 (81.3%)	92 (84.4%)
3, n, (%)	29 (7.6%)	21 (7.7%)	8 (7.3%)
4, n, (%)	9 (2.4%)	6 (2.2%)	3 (2.8%)
5, n, (%)	6 (1.6%)	4 (1.5%)	2 (1.8%)
Comorbid diseases
Hypertension, n, (%)	256 (67.2%)	188 (69.1%)	68 (62.4%)	0.206*
Coronary heart disease, n, (%)	70 (18.4%)	51 (18.8%)	19 (17.4%)	0.764*
Diabetes mellitus, n, (%)	65 (17.1%)	51 (18,8)	14 (12.8%)	0.166*
Cerebrovascular diseases, n, (%)	44 (11.5%)	32 (11.8%)	12 (11.0%)	0.835*
Preoperative parameters
Total prostate volume, cm3, median (IQR)	82.0 (50.0–115.0)	80.0 (60.0–109.2)	90.0 (60.0–120.0)	0.304
IPSS, score, median (IQR)	25.0 (21.0–30.0)	24.0 (21.0–30.0)	26.0 (21.0–32.0)	0.141
QoL, score, median (IQR)	5.0 (4.0–6.0)	5.0 (4.0–6.0)	5.0 (4.0–6.0)	0.745
Qmax, ml/sec, median (IQR)	9.2 (7.2–12.0)	9.6 (7.5–12.0)	8.3 (6.5–11.0)	0.017
PVR, ml, median (IQR)	75.0 (46.0–120.0)	72.0 (40.0–120.0)	85.0 (56.0–115.0)	0.290
PSA, ng/dL median (IQR)	4.0 (2.2–7.0)	4.0 (2.3–7.1)	4.0 (1.8–6.9)	0.352
Indwelling catheter, n, (%)	86 (22.6%)	67 (24.6%)	19 (17.4%)	0.129*
Duration of indwelling catheter				0.535***
Less than 6 months, n, (%)	64 (75.3%)	50 (75.8%)	14 (73.7%)
6 months and more, n, (%)	21 (24.7%)	16 (24.2%)	5 (26.3%)
Intraoperative parameters
Total laser energy, kJ, median (IQR)	55.0 (42.0–75.3)	54.5 (40.3–74.1)	58.4 (43.2–80.2)	0.143
Early sphincter release, n, (%)	318 (83.5%)	230 (84.6%)	88 (80.7%)	0.364*
Enucleation technique				<0.001*
3-lobe, n, (%)	21 (5.5%)	8 (2.9%)	13 (11.9%)
2-lobe, n (%)	306 (80.3%)	216 (79.4%)	90 (82.6%)
En-bloc, n (%)	54 (14.2%)	48 (17.7%)	6 (5.5%)
Operation time, min, median (IQR)	75.0 (60.0–100.0)	75.0 (60.0–100.0)	75.0 (55.0–100.0)	0.989
Enucleation time, min, median (IQR)	55.0 (40.0–75.0)	55.0 (40.0–70.0)	50.0 (40.0–80.0)	0.979
Morcellation time, min, median (IQR)	25.0 (17.0–30.0)	20.0 (15.0–30.0)	25.0 (20.0–35.0)	0.275
Anesthesia				0.342*
General, n, (%)	52 (13.6%)	40 (14.7%)	12 (11.0%)
Spinal, n, (%)	329 (86.4%)	232 (85.3%)	97 (89.0%)
Catheterization time, days, median (IQR)	2.0 (2.0–3.0)	2.0 (2.0–3.0)	2.0 (2.0–3.0)	0.758

* Pearson’s chi-square test with Yates’s continuity correction; **one-tailed Fisher’s exact test; without *Pearson’s chi-square test.

Table 3. Univariate logistic regression analysis of risk factors for UI following ThuFLEP.

	Incontinence overall n=109		< 1 months n=46		1 to 3 months n=57		> 3 months n=6
	OR (95% CI)	р	OR (95% CI)	р	OR (95% CI)	р	OR (95% CI)	р
Age, years	1.020 (0.992–1.049)	0.158	0.979 (0.933–1.027)	0.389	1.019 (0.971–1.069)	0.455	1.030 (0.934–1.136)	0.557
ASA, score	1.156 (0.810–1.651)	0.424	0.648 (0.313–1.339)	0.241	1.529 (0.746–3.137)	0.246	1.057 (0.285–3.922)	0.934
Preoperative parameters
Total prostate volume, cm3	1.004 (0.999–1.008)	0.101	1.001 (0.994–1.008)	0.772	0.998 (0.991–1.005)	0.616	1.005 (0.994–1.017)	0.359
IPSS, score	1.038 (0.992–1.085)	0.106	1.045 (0.970–1.126)	0.244	0.953 (0.882–1.028)	0.213	1.031 (0.847–1.254)	0.762
Qmax, ml/sec	0.944 (0.880–1.012)	0.106	0.922 (0.823–1.033)	0.161	1.097 (0.974–1.236)	0.126	0.862 (0.588–1.264)	0.447
PVR, ml	1.000 (0.998–1.003)	0.901	1.002 (0.997–1.007)	0.461	0.998 (0.992–1.003)	0.377	1.004 (0.994–1.014)	0.473
Indwelling catheter	0.646 (0.367–1.138)	0.131	2.161 (0.791–5.900)	0.133	0.347 (0.127–1.106)	0.076	2.529 (0.429–14.929)	0.306
Intraoperative parameters
Total laser energy, kJ	1.009 (1.001–1.018)	0.036	1.003 (0.990–1.016)	0.697	0.996 (0.983–1.010)	0.566	1.010 (0.986–1.035)	0.413
Early sphincter release vs standard	0.765 (0.429–1.365)	0.365	0.258 (0.080–0.828)	0.023	0.244 (0.075–0.792)	0.019	1.205 (0.133–10.894)	0.868
Enucleation technique (En-bloc vs 2-lobe or 3-lobe)	0.272 (0.113–0.656)	0.004	0.258 (0.029–2.285)	0.223	4.327 (0.487–38.423)	0.189	-	0.999
Operation time, min	1.002 (0.995–1.008)	0.659	0.992 (0.980–1.004)	0.178	1.008 (0.996–1.021)	0.167	0.999 (0.975–1.024)	0.942
Enucleation time, min	1.003 (0.994–1.013)	0.491	0.991 (0.976–1.006)	0.247	1.010 (0.994–1.026)	0.207	0.992 (0.957–1.029)	0.679
Morcellation time, min	1.011 (0.990–1.033)	0.287	0.964 (0.924–1.006)	0.091	1.036 (0.992–1.082)	0.107	1.023 (0.950–1.101)	0.553
Catheterization time, days	0.926 (0.758–1.131)	0.451	1.088 (0.758–1.562)	0.647	0.905 (0.627–1.305)	0.539	1.135 (0.563–2.287)	0.723

Table 4. Multivariate logistic regression analysis of risk factors for UI following ThuFLEP.

	Incontinence overall n=109		< 1 month n=46		1 to 3 months n=57
	OR (95% CI)	р	OR (95% CI)	р	OR (95% CI)	р
Age	1.020 (0.984–1.041)	0.413	1.015 (0.966–1.066)	0.562	1.011 (0.961–1.063)	0.675
Total prostate volume	1.000 (0.991–1.008)	0.931	1.003 (0.990–1.016)	0.656	1.003 (0.989–1.016)	0.711
Total laser energy	1.007 (0.991–1.023)	0.389	0.995 (0.970–1.020)	0.695	0.994 (0.969–1.020)	0.651
Early sphincter release vs standard	0.715 (0.395–1.294)	0.268	0.257 (0.078–0.849)	0.026	0.244 (0.073–0.818)	0.022
Enucleation technique (En-bloc/2-lobe or 3-lobe)	0.302 (0.123–0.739)	0.009	4.415 (0.484–40.259)	0.188	4.885 (0.535–44.615)	0.160