Stress urinary incontinence following thulium fiber laser enucleation of the prostate: incidence and risk factors analysis
Abstract
Introduction . Thulium fiber laser enucleation of the prostate (ThuFLEP) is an effective, minimally invasive surgical option for benign prostatic obstruction, enabling complete anatomical adenoma removal with excellent hemostasis and applicability across a wide range of prostate volumes. Despite the high efficacy of endoscopic enucleation techniques, early postoperative stress urinary incontinence (SUI) remains one of the most clinically relevant functional complications, adversely affecting patients’ quality of life and satisfaction with surgery. Objective. To determine the incidence and potential risk factors for SUI following ThuFLEP performed by a single surgeon with experience of more than 3000 endoscopic enucleations. Materials & methods. Between May 2021 and September 2022, ThuFLEP was performed in 381 patients. The FiberLase U3 system (IRE Polus Ltd., Fryazino, Russia) was used as the laser source, with standard settings of 1.5 J, 40 Hz, 60 W. Results. SUI occurred in 45 patients (11.8%) after ThuFLEP. Only one patient (0.3% of the cohort) had symptoms persisting beyond 3 months, whereas SUI resolved within 3 months in the remaining 99.7% of cases. Urethral pressure profilometry in the single patient with persistent SUI demonstrated marked sphincter insufficiency, which was successfully managed with comprehensive rehabilitation. On univariate regression analysis, preoperative IPSS was identified as a risk factor for SUI: each one-point increase in IPSS was associated with a 1.074-fold rise in the odds of SUI (95% CI 1.007–1.145, p = 0.029). Use of the en-bloc technique emerged as a protective factor, reducing the odds of SUI by 89.4% (95% CI 0.014–0.789, p = 0.028). Multivariate regression analysis showed a similar trend, although the differences did not reach statistical significance, in line with prior ThuFLEP series. Conclusion. SUI after ThuFLEP is observed in 11.8% of patients and resolves within 3 months in 99.7% of cases. Greater baseline symptom severity as measured by IPSS increases the risk of postoperative SUI, whereas en-bloc ThuFLEP appears to confer a protective effect.