Urodynamic risk factors for transient urinary incontinence after endoscopic enucleation of prostate hyperplasia

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Introduction: Urinary incontinence in men after endoscopic enucleation of benign prostate hyperplasia (BPH) can reach 55% and significantly impairing the quality of life and social rehabilitation of patients. A large number of individual patient parameters and features of surgical treatment are considered as potential risk factors. At the same time, the influence of urodynamic factors, including the external urethral sphincter function at the preoperative stage, fades into the background, and research on this issue is extremely limited.

Objective: comprehensive assessment of urodynamic risk factors for urinary incontinence after endoscopic enucleation of BHP.

Materials and methods. This prospective study included 69 patients who underwent endoscopic enucleation of BPH (thulium fiber enucleation – 62 patients, bipolar enucleation – 7 patients) performed by single surgeon between October 2023 and August 2024. All patients underwent an invasive urodynamic study 1 day before the planned surgical treatment, including uroflowmetry, cystometry, flow/pressure study and profilometry performed by single urologist. In the postoperative period, the presence and duration of urinary incontinence were recorded in accordance with the definition of the International Continence Society. Statistical data processing was carried out using RStudio software in the R programming language.

Results. Transient urinary incontinence after endoscopic enucleation was detected in 36.2% patients. In 100% cases, the duration of incontinence did not exceed a 3-month period. The independent urodynamic predictors of urinary incontinence were the bladder outlet obstruction index (BOOI), the bladder contractility index (BCI) and maximum intraurethral pressure (Pura max). Thus, with an increase in BOOI for 1 unit, the chance of urinary incontinence increased by 1,027 times or 2.7% (OR=1,027; 95%CI=1,003–1,052; p=0,027). With an increase in BCI for every 1, the chance of urinary incontinence increased by 1,020 times or 2.0% (OR=1,020; 95%CI=1,001–1,039; p=0,043). Large values of Pura max, on the contrary, led to a decrease in the chance of urinary incontinence, thereby acting as a protective factor. With an increase in Pura max for every 1 cm of H2O, the chance of urinary incontinence decreased by 1,087 times or by 8% (OR=0,920; 95%CI=0,876–0,966). The overall accuracy of the proposed model was 88,1% with sensitivity and specificity of 90,5 and 86,8% (ROC–AUC=0,897). The only independent intraoperative factor associated with urinary incontinence was the operation time: with an increase in the operation time for every 1 minute, the chance of urinary incontinence increased by 1,022 times or by 2,2%, regardless of the type of energy used and the early sphincter release (OR=1,022; 95%CI=1,005–1.040; p=0,011; ROC–AUC=0,721).

Conclusion. The chance of urinary incontinence at longer endoscopic enucleation, higher BOOI and BCI and low Pura max increases, which, thereby, can be used in predicting the functional results of endoscopic enucleation, taking into account individual urodynamic risk factors.

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Sobre autores

Nikolay Sorokin

Lomonosov Moscow State University

Email: nisorokin@mail.ru
ORCID ID: 0000-0001-9466-7567

M.D., Dr.Sc.(Med), Prof., Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute, Leading Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute

Rússia, Moscow

Olga Nesterova

Lomonosov Moscow State University

Autor responsável pela correspondência
Email: oy.nesterova@gmail.com
ORCID ID: 0000-0003-3355-4547

M.D., Cand. Sc. (Med), Urologist, Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute, senior lecturer of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute

Rússia, Moscow

Maksim Khokhlov

Lomonosov Moscow State University

Email: uromax78@mail.ru
ORCID ID: 0009-0004-5045-0365

M.D., Cand. Sc. (Med), Urologist, Urology Division, University Clinic, Medical Scientific and Educational Institute

Rússia, Moscow

David Kamalov

Lomonosov Moscow State University

Email: davidffm@mail.ru
ORCID ID: 0009-0003-3069-7128

M.D., Cand. Sc. (Med), Urologist, Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute, associate professor of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute

Rússia, Moscow

Vitaly Dzitiev

Lomonosov Moscow State University

Email: vitdok@mail.ru
ORCID ID: 0000-0001-7558-589X

M.D. Cand.Sc.(Med); Head, Urology Division, University Clinic, Medical Scientific and Educational Institute, Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute

Rússia, Moscow

Andrey Strigunov

Lomonosov Moscow State University

Email: an-strigunov@yandex.ru
ORCID ID: 0000-0003-4518-634X

M.D., Cand. Sc. (Med), Urologist; Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute

Rússia, Moscow

Anastasia Tereshina

Lomonosov Moscow State University

Email: tereshinaanastasia51@gmail.com
ORCID ID: 0009-0008-0589-2438

5th grade student of Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Rússia, Moscow

Arina Veriaskina

Lomonosov Moscow State University

Email: arina.ver.15@mail.ru
ORCID ID: 0009-0008-6926-2195

5th grade student of Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Rússia, Moscow

Armais Kamalov

Lomonosov Moscow State University

Email: armais.kamalov@rambler.ru
ORCID ID: 0000-0003-4251-7545

M.D., Dr.Sc.(Med), Full Prof., Academician of the Russian Academy of Sciences; Director, University Clinic, Medical Scientific and Educational Institute, Head, Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute

Rússia, Moscow

Akhmedkhan Pshikhachev

Central Clinical Hospital of Civil Aviation; Maykop State Technological University Medical Institute

Email: pshich@yandex.ru
ORCID ID: 0000-0002-4424-3261

Dr.Sc.(Med), Professor, Deputy Chief Physician for Medical Affairs, Acting Head and Professor of the Department of Urology and General Surgery

Rússia, Moscow; Maykop

Alexey Mikhalchenko

Lomonosov Moscow State University

Email: mihaleksei@mail.ru
ORCID ID: 0009-0001-4035-3260

Urologist, Trainee Researcher Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute

Rússia, Moscow

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2. Fig. 1. Urodynamic parameters in patients with and without urinary incontinence after endoscopic enucleation of prostatic hyperplasia: A — volume at which the first urge to urinate arose, B — volume at which a strong urge to urinate arose, C — contractility index, G — infravesical obstruction index, D — maximum intraurethral pressure

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