"Post Void Residual and Bladder Capacity Predict Urinary Continence Following Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia".

Objectives: To better understand and potentially predict transient urinary incontinence (TUI) following Holmium laser enucleation of the prostate (HoLEP), we investigated whether preoperative urodynamic studies (UDS), the gold standard for assessing bladder physiology, can identify patients at higher risk for TUI.

Methods: We conducted a single-institution retrospective cohort study of patients who underwent UDS followed by HoLEP for BPH between 2017 and 2023. We collected data on baseline characteristics, UDS parameters, and perioperative outcomes. The primary outcome was urinary incontinence (UI) at 1, 3, 6, and 12 months post-surgery.

Results: 129 subjects were identified and univariate analysis demonstrated that post-operative UI rates were lower in patients with a preoperative post-void residual (PVR) greater than 250mL when compared to those with a PVR ≤250mL at 3 months (33.3% vs. 55.6%;p=0.02) and 6 months (11.5% vs. 39.2%;p<0.01). Similarly, patients with a bladder capacity exceeding 600mL experienced lower UI rates at 1 month (p=0.01), 6 months (p<0.01), and 12 months (p=0.03) compared to those with a bladder capacity ≤600mL. Furthermore, adjusted analysis confirmed these findings that PVR >250mL and bladder capacity >600mL were associated with a 28% (95%CI [12.1%-43.3%];p<0.01) and 26% (95%CI [13.2%-39%];p<0.01) lower probability of UI at 6 months, respectively.

Conclusions: Adding baseline PVR and bladder capacity assessment to the preoperative evaluation may supplement counseling on protective factors for UI following HoLEP.