Holmium laser enucleation of the prostate (HoLEP) is as an effective, size-independent treatment for benign prostatic hyperplasia (BPH) with durable outcomes. However, one of its adverse outcomes is post-operative stress urinary incontinence (SUI).
We sought to determine if membranous urethral length (MUL) as measured on preoperative magnetic resonance imaging is a predictor for post-operative SUI in patients undergoing HoLEP for BPH.
A single-center, retrospective observational study was conducted on 147 consecutive patients who underwent HoLEP for BPH between 2018 and 2024. Preoperative baseline characteristics, perioperative details, and SUI outcomes at 1, 3, and 6 months were collected. Binary logistic regression was used to assess the association between MUL and SUI at each follow-up interval.
Median MUL was 8.2 mm (IQR 6.1-11.0), and post-operative SUI incidences were 73 (49.7%), 36 (24.5%), and 16 (10.9%) at 1, 3, and 6 months respectively. Longer MUL was significantly associated with lower odds of SUI at 1 month (OR: 0.86, 95% CI: 0.77-0.96, p = 0.009), 3 months (OR: 0.77, 95% CI: 0.65-0.91, p = 0.002), and 6 months (OR: 0.65, 95% CI: 0.49-0.87, p = 0.004). Internal validation demonstrated good discrimination (areas under the curve of 0.73, 0.75, and 0.83 at 1, 3, and 6 months) with well-calibrated models, and decision curve analysis confirmed clinical utility within prespecified risk thresholds.
Longer MUL is significantly associated with lower rates of SUI following HoLEP at 1, 3, and 6 months. Longer MUL may serve as a valuable predictive factor for continence recovery and should be considered during preoperative counseling and surgical decision planning.
World journal of urology. 2026 Jan 30*** epublish ***
Nick Lee, Tarek Benzouak, David-Dan Nguyen, Sébastien Belliveau, Liam Murad, Lynda Kadi, Nathan Perlis, Rodney H Breau, Dean Elterman, Bilal Chughtai, Dan R Gralnek, Damien Olivié, Malek Meskawi, Cristina Negrean, Naeem Bhojani
Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. ., Faculty of Medicine, McGill University, Montreal, QC, Canada., Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada., Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Department of Radiology, Université de Montréal, Montréal, QC, Canada., Division of Urology, Department of Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada., Department of Urology, Northwell Health, Manhasset, NY, USA., Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41615485