[Prevention of transient urinary incontinence in peri-operative period of modified holmium laser enucleation of the prostate (HoLEP)].

From February 2005 to April 2007, 48 consecutive patients with BPH underwent holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation. The first 14 cases (group 1) underwent HoLEP according to Gilling's method. In the next consecutive 17 cases (group 2), in addition to HoLEP performed as in group 1, the urethral external sphincter was stimulated electrically with a needle electrode inserted in a transperineal manner to prevent sphincteric injury. In the latter 17 consecutive cases (group 3), we used a modified HoLEP procedure, which partially preserved the apical adenoma in the 10-to 2-o'clock position. International Prostate Symptom Score, quality of life index, urinary flow (Qmax) data, and postvoid residual urine were significantly improved postoperatively in each group, there being no differences among them with the exception that group 3 had better Qmax data than group 3 at one month after operation. On the other hand, postoperative transient urinary incontinence was significantly reduced in group 3 on the day of discharge and 1 month after the operation. These results demonstrate that our modified HoLEP procedure is a promising method to avoid postoperative transient urinary incontinence.