System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ppublish

PubMed: 40273412 DOI: 10.5489/cuaj.9099

Modified early apical release vs. non-early apical release in holmium laser prostatic enucleation Impact on stress urinary incontinence.

Can Urol Assoc J 19(8):242-248

Authors: Abdulghani Khogeer, Adel Elatreisy, Ahmed S Zugail, Yousef Almehmadi, Ahmed Ibrahim, Serge Carrier, Mélanie Aubé-Peterkin

Affiliations

  • Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
  • Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
  • Department of Urology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
  • Division of Urology, Department of Surgery, McGill University Health Center, Montreal, QC, Canada.

Abstract

INTRODUCTION

We aimed to compare the incidence of de novo stress urinary incontinence (SUI) of two apical release techniques for holmium laser prostatic enucleation (HoLEP): modified early apical release (EAR) and non-early apical release (non-EAR).

METHODS

We conducted a retrospective database review analyzing the records of patients who underwent HoLEP with the modified EAR and non-EAR techniques for symptomatic benign prostatic hyperplasia. The study period spanned from January 2012 to December 2021 in a single center. Patient demographics, perioperative data, and functional and technical outcomes were compared between the techniques.

RESULTS

The study included a total of 786 patients; 556 patients underwent the non-EAR technique (group 1), and 230 underwent the modified EAR technique (group 2). The mean enucleated prostate weight in group 1 was 68.2±45.6 g compared to 93.3±51.9 g in group 2 (p<0.001). De novo SUI within a month of surgery was reported in 34 cases (6.1%) in group 1 compared to eight cases (3.5%) in group 2. The percentage of patients with persistent SUI at one year postoperatively dropped to 2.7% and 0.9% in the non-EAR and modified EAR groups, respectively. Moreover, persistent SUI after one year from surgery was reported in 1.4 % of the non-EAR group compared to 0.44% in the modified EAR group. Multivariate regression analysis demonstrated that age >70 years (p=0.06), operative time >90 minutes (p=0.011), and the non-EAR technique (p=0.004) were significantly associated with the onset of postoperative de novo SUI.

CONCLUSIONS

Our research indicates that both modified EAR and non-EAR techniques employed during HoLEP yield comparable efficacy and safety outcomes. Nonetheless, the modified EAR technique is associated with reduced postoperative de novo SUI.

MeSH

Stress, Physiological, Prostate, Ear, Lasers, Urinary Incontinence, Holep