Department of Urology, Rush University, Chicago, IL, USA.
Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy.
Minerva Urol Nephrol. 2024 Oct;76(5):618-624. doi: 10.23736/S2724-6051.24.05802-6.
Postoperative urinary incontinence (UI) is a feared complication of BPH surgery. Our study aims to investigate the incidence of UI among patients undergoing different procedures for BPH.
A retrospective analysis was conducted using a large national database, containing patient records between 2011 and 2022. The most employed surgical procedures for BPH were considered, including TURP, Transurethral Incision of the Prostate (TUIP), Holmium/Thulium Laser Enucleation of the Prostate (HoLEP/ThuLEP), Open Simple Prostatectomy (OSP), minimally invasive simple prostatectomy (Lap/Rob SP), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Robotic Waterjet Treatment (RWT - Aquablation), Water Vapor Thermal Therapy (WVTT - Rezum) and Prostatic Artery Embolization (PAE). Rates of any type of UI, including stress UI (SUI), urge UI (UUI) and mixed UI (MUI) were assessed. Multivariate regression analysis was used to identify predictors of "persistent" postoperative UI, defined as the presence of an active UI diagnosis at 12 months post-surgery.
Among 274,808 patients who underwent BPH surgery, 11,017 (4.01%) experienced persistent UI. UUI rates varied between 0.62% (PAE) and 2.71% (PVP), SUI ranged from 0.04% (PAE) and 2.75% (Lap/Rob SP), while MUI between 0.11% (PAE) and 1.17% (HoLEP/ThuLEP). On multivariable analysis, HoLEP/ThuLEP (OR 1.612; 95% CI: 1.508-1.721; P<0.001), PVP (OR 1.164; 95% CI:1.122-1.208; P<0.001), Open SP (OR 1.424; 95% CI:1.241- 1.624; P<0.001), and Lap/Rob SP (OR 1.667; 95% CI:1.119-2.384; P<0.01) showed significant higher likelihood of UI compared to TURP. PUL (OR 0.604; 95% CI:0.566-0.644; P<0.001), WVTT (OR 0.661; 95% CI:0.579-0.752; P<0.001), RWT (OR 0.434; 95% CI:0.216-0.767; P<0.01), and PAE (OR 0.178; 95% CI:0.111-0.269; P<0.001) were associated with lower likelihood of UI.
UI remains a concerning complication following BPH surgery, but it is an uncommon event affecting <5% of patients. Some differences in UI rates and risk might exist among various BPH procedures. These findings underscore the need for thorough patient selection and counseling.
术后尿失禁（UI）是 BPH 手术的一种令人担忧的并发症。我们的研究旨在调查不同 BPH 手术患者 UI 的发生率。
使用包含 2011 年至 2022 年患者记录的大型国家数据库进行回顾性分析。考虑了最常使用的 BPH 手术程序，包括经尿道前列腺切除术（TURP）、经尿道前列腺切开术（TUIP）、钬/钕激光前列腺剜除术（HoLEP/ThuLEP）、开放性单纯前列腺切除术（OSP）、微创单纯前列腺切除术（Lap/Rob SP）、前列腺尿道电切术（PVP）、前列腺尿道悬吊术（PUL）、水射流治疗（RWT- Aquablation）、蒸汽热疗（Rezum）和前列腺动脉栓塞术（PAE）。评估了任何类型 UI 的发生率，包括压力性 UI（SUI）、急迫性 UI（UUI）和混合性 UI（MUI）。使用多变量回归分析来确定“持续性”术后 UI 的预测因素，定义为术后 12 个月存在活动性 UI 诊断。
在 274808 例接受 BPH 手术的患者中，11017 例（4.01%）经历了持续性 UI。UUI 发生率在 0.62%（PAE）和 2.71%（PVP）之间，SUI 范围从 0.04%（PAE）到 2.75%（Lap/Rob SP），而 MUI 在 0.11%（PAE）和 1.17%（HoLEP/ThuLEP）之间。多变量分析显示，HoLEP/ThuLEP（OR 1.612；95%CI：1.508-1.721；P<0.001）、PVP（OR 1.164；95%CI：1.122-1.208；P<0.001）、开放性 SP（OR 1.424；95%CI：1.241-1.624；P<0.001）和 Lap/Rob SP（OR 1.667；95%CI：1.119-2.384；P<0.01）与 TURP 相比，UI 的发生可能性显著更高。PUL（OR 0.604；95%CI：0.566-0.644；P<0.001）、WVTT（OR 0.661；95%CI：0.579-0.752；P<0.001）、RWT（OR 0.434；95%CI：0.216-0.767；P<0.01）和 PAE（OR 0.178；95%CI：0.111-0.269；P<0.001）与 UI 的发生可能性较低相关。
UI 仍然是 BPH 手术后令人担忧的并发症，但它是一种罕见的事件，影响不到 5%的患者。不同 BPH 手术程序之间可能存在 UI 发生率和风险的差异。这些发现强调了需要对患者进行彻底的选择和咨询。
