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Int Neurourol J > Volume 20(1); 2016 > Article
Shigemura, Tanaka, Yamamichi, Chiba, and Fujisawa: Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons’ Experience During Learning Curve

ABSTRACT

Purpose:

To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP) according to surgeon experience (beginner or experienced) and preoperative clinical data.

Methods:

Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO). We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (<21 cases) and experienced (≥21 cases).

Results:

Our statistical data showed DO was a significant predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000). Additionally, patient age, surgeon mentorship (inverse correlation), and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively). With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse) at the super-short period, and patient age and mentorship (inverse correlation) at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively) were significant predictive factors for beginners, and first desire to void (FDV) at 1 month after HoLEP (OR, 1.009; P=0.012) was a significant predictive factor for experienced surgeons in multivariate analysis.

Conclusions:

Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient’s quality of life with regards to urinary continence.

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    INTRODUCTION

    Holmium laser enucleation of the prostate (HoLEP) is performed, more routinely than before, for the surgical management of benign prostate hyperplasia (BPH) as it is becoming a substitute for transurethral resection of the prostate (TURP), especially in specific groups of patients with enlarged prostates [1]. HoLEP is considered a more accessible technique, but does involve a particularly steep learning curve in comparison with other surgical modalities for BPH [2]. Even though HoLEP is now widespread and offers good patient outcomes for lower urinary tract symptoms (LUTS), with less blood loss during surgery and minimal influence on the prostate capsule compared to TURP and other modalities [3], postoperative urinary incontinence remains a representative complication of HoLEP and can have a negative influence on the patient’s quality of life (QoL) [4]. This adverse event is of particular concern in the cases encountered by surgeons during the learning curve. Montorsi et al. [5] reported that urinary incontinence was more frequent after HoLEP than after other modalities, including TURP. Several studies have since sought to identify predictive factors for post-HoLEP incontinence [6]; however, most of these studies have chosen subjective evaluations. For instance, they have considered symptom scores, such as the International Prostate Symptom Score (IPSS), or surgery-related factors, such as surgical time and surgeon experience or enucleation efficiency, as potential predictive factors. More importantly, this type of study has usually been conducted within a high-volume center by experienced surgeons and, as such, information on patient outcomes associated with surgeon experience, particularly for beginner surgeons, is generally lacking.
    Regarding the influence of surgeon experience on post-HoLEP incontinence in patients, Kim et al. [7] concluded that the surgeon’s skills with the HoLEP procedure might plateau after approximately 25 cases. The overall occurrence of postoperative incontinence has been reported to be approximately 16.2% [4]. Kwon et al. [8] later showed that involuntary detrusor contractions in urodynamic studies (UDS) were significantly improved after surgical management with HoLEP.
    In this study, we evaluated potential predictive factors for postoperative incontinence following HoLEP, focusing on surgeon experience (beginner or experienced) in combination with preoperative UDS data.

    MATERIALS AND METHODS

    Patients and Surgeons

    Of all the procedures performed (n=224) at Kobe University Hospital from 2006 to 2014, a total of 203 patients, for whom data on urinary incontinence was available, were included in this study. Urinary incontinence was defined as involuntary leakage of urine, in accordance with the recommendations of the International Continence Society [9], that required the use of pads. Incontinence was evaluated at the super-short period (the day after catheter removal), and at 1 and 3 months after HoLEP. We defined a mentor (mentorship) as a surgeon who had experience with 50 or more cases of HoLEP and included only one mentor in this study. This is a retrospective study and all study-related procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

    Urodynamic Examination

    Urodynamic examination, including free uroflowmetry, filling cystometry, and pressure flow studies was performed before HoLEP [10]. We obtained informed consent by way of patient signatures for UDS. Briefly, 5-Fr feeding tubes were inserted transurethrally for bladder filling and for measuring intravesical pressure during cystometry, and an 8-Fr tube was inserted into the rectum to measure rectal pressure. The parameters investigated included maximum cystometric capacity, bladder volume at the time of the first involuntary detrusor contraction, detrusor pressure at the time of the highest involuntary detrusor contraction, and bladder compliance. The primary outcome parameters derived from the UDS results were: maximal voiding pressure (MVP), compliance, detrusor overactivity (DO), Schafer classification, volume of first desire to void (FDV), maximum cystometric capacity (MCC), and residual volume (RV) [10,11].

    Holmium Laser Enucleation of the Prostate

    Patients who underwent HoLEP with full UDS data were enrolled in this study. Patients with LUTS owing to BPH and who were also suspected of having prostate cancer underwent prostate biopsies first, and only patients without cancer were recommended for HoLEP. The surgical procedures carried out were as those described previously [12]. The laser setting was 72–100 W (1.8–2.5 J and 30–40 Hz). The HoLEP equipment included a high power 100-W Ho:YAG laser (VersaPulse Select; Lumenis Inc., Yokneam, Israel), a 550-μm fiber (SlimLine 550; Lumenis Inc.), a modified 26-Fr Storz continuous-flow resectoscope with a working element for stabilizing the laser fiber, a Storz rigid nephroscope, and a tissue morcellator (VersaCut system; Lumenis Inc.). Catheter indwelling time after HoLEP was 1–3 days as a rule. We herein refer to mentorship as the surgery with help by mentor as mentioned above [13].

    Predictive Factors for Postoperative Incontinence

    We investigated the predictive factors for postoperative incontinence following HoLEP, including potential factors, such as patient age, preoperative IPSS/QoL, the surgeon’s experience (beginners: 20 cases or less; experienced: 21 cases or more), the presence of a mentor at the surgery (mentorship), and prostate size, as well as UDS factors, including MVP, compliance, DO, Schafer classification, FDV, MCC, and RV.

    Statistical Analyses

    For statistical analyses, univariate and multivariate tests were performed using StatView 5.0 software (Abacus Concepts Inc., Berkley, CA, USA). Forward stepwise logistic regression analysis was conducted to determine the association between various parameters and postoperative urinary incontinence status. Statistical significance was established at the level of P<0.05.

    RESULTS

    Patient and Surgeons

    Patient characteristics are shown in Table 1. Briefly, the median patient age was 71 years (range, 34–90 years). Resected prostate weight was 52.9±35.3 g (Table 1). Prostate cancer was detected in 16 cases (7.88%). We included 11 surgeons in this study and 10 beginner surgeons performed 119 cases indicated for HoLEP. The number of patients with incontinence at the super-short period, and at 1 and 3, and 6 months after HoLEP for cases treated by beginner surgeons was 47 (39.5%), 35 (29.4%), 20 (16.8%), and 6 (5.04%) (data not shown), respectively, and for cases treated by experienced surgeons was 33 (39.3%), 32 (38.1%), 11 (13.1%), and 4 (4.76%) (data not shown), respectively.

    Predictive Factors for Post-HoLEP Incontinence

    We investigated the predictive factors for urinary incontinence for the super-short period, and at 1 and 3 months after HoLEP. Our statistical data are shown in Tables 210. Briefly, in the investigation of all surgeons, preoperative DO was a significant predictive factor at the super-short period after HoLEP (odds ratio [OR], 3.336; P=0.000). Even though the following variables had comparatively lower OR, patient age and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004 and OR, 1.008; P=0.049, respectively). Importantly, in the multivariate analyses, mentorship during surgery was an inverse significant predictive factor at the 1-month interval (OR, 0.251; P=0.002) in all patient categories.
    In the classification of surgeon experience, briefly, DO and preoperative IPSS (inverse) at the super-short period after HoLEP, and patient age and mentorship (inverse correlation) at the 1 month (OR, 0.892; P=0.003; OR, 7.069; P=0.001 and OR, 1.084; P=0.015; OR, 0.358; P=0.026, respectively) and preoperative IPSS (inverse) (OR, 0.911; P=0.040) at the 3 months for beginner surgeons, were identified as significant predictive factors in multivariate analyses, and FDV at the 1-month interval after HoLEP (OR, 1.009; P=0.012) performed by experienced surgeons, was identified as a significant predictive factor in univariate analyses. These results suggest that preoperative DO is significantly correlated with incontinence at the super-short period after HoLEP considering the high OR value; for experienced surgeons, DO tended to be a predictive factor with a high OR (2.624) although this finding was not statistically significant. Importantly, mentorship significantly contributed to patient outcome with regards to continence at 1 month following HoLEP (Tables 210). However, no significant predictive factors were identified in either experienced surgeon category at and 3-month interval after HoLEP in experienced surgeons.

    DISCUSSION

    Post-HoLEP incontinence has been issued as the main adverse event [14]; however, it should be prevented because patients are generally able to maintain continence preoperatively. Lerner et al. [6] stated that the risk factors for post-HoLEP stress incontinence include the number of days between cases for surgeons. On the other hand, there is a study describing a learning curve that the postoperative transient urinary incontinence rate was higher in initial cases (No. 1–50) than in the other groups (No. 51–100 and No. 101–190) [15]. Therefore, we investigated the predictive factors for post-HoLEP incontinence from the super-short period to 3 months after surgery, with a particular focus on the surgeon’s level of experience. There are some arguments regarding the clinical validity of investigating the super-short period after HoLEP [16,17]; however, we believe incontinence may damage patient QoL even during the period immediately following the procedure, and, as such, we chose to include this timeframe in our examination.
    In general, post-HoLEP incontinence may be due to an imbalance between the bladder’s storage functions, following release of the bladder outlet obstruction, and sphincter function after HoLEP [18]. Several studies have addressed the damage to the sphincter as a risk factor for post-HoLEP incontinence, and surgical time and the surgeon’s skill level can affect the risk of the sphincter damage [19]. Shah et al. [20] found, in their 280-case study, that the surgeon’s experience was a significant factor for post-HoLEP incontinence, because inexperienced surgeons tended to be disoriented, and may inadvertently cause sphincter damage, or may encounter delays when dealing with the membrane at the prostate apex such that tension in the membrane would damage or affect the nearby sphincter. As to the strategies for decreasing post-HoLEP incontinence, Jeong et al. [21] stated that surgeons needed to have experience with at least 25 cases to optimize their technique, even though the learning curve for HoLEP is steep compared to other modalities, such as TURP. In addition, the presence of a mentor (mentorship) at the surgery tended to decrease surgical complications and offer better patient outcomes when compared with surgeries where no mentor was present [22]. Related to this issue, our data showed that in particular DO and mentorship (inverse correlation) were significant predictors for post-HoLEP incontinence for beginner surgeons. Moreover, FDV was a significant predictive factor for experienced surgeons, suggesting, taken together, that mentorship contributes to the prevention of post-HoLEP incontinence and the education system works well for this purpose.
    Bruschini et al. [23] stated that preoperative DO or urethral sphincter insufficiency was a significant factor in urinary incontinence following surgery for BPH. Our UDS and post-HoLEP incontinence data also showed that DO was a significant factor in the super-short period after HoLEP (the next day of catheter removal) and this finding is emphasized for non-experienced surgeons.
    Our data also showed that patient age was a significant predictive factor for incontinence at the 1-month interval for beginner surgeons. However, Lerner et al. [6] stated that they found no significant differences in patient age between those with and without incontinence at 3 months following HoLEP. Elmansy et al. [18] reported that diabetes mellitus, but not patient age, was significantly associated with a higher incidence of incontinence. This difference could be attributed to the variation in sample sizes: n=66 (Lerner et al. [6]) and n=954 (Elmansy et al. [18]) vs. n=203 in our study, as well as, the number of surgeons included. To our knowledge, there are no reports that have investigated the predictive factors for post-HoLEP incontinence, as classified according to the surgeons’ level of experience. Our data showed that the significant predictive factors identified for post-HoLEP in each surgeon category (based on experience) are informative, even for surgeons with a variety of experience. However, we identified no significant predictive factors in the investigation at 3 months after HoLEP in experienced surgeons; therefore, a longer period of observation is necessary as well.
    A number of study limitations also remain to be addressed. First, this is a retrospective audit of patient outcomes from a single-center study. Second, several UDS parameters, including urethral length and maximum urethral closure pressure, were not assessed. Third, we did not investigate severity or type, as well as, the continuation of incontinence, with objective tests, such as the pad test or bladder diary and did not include a definitive training program for the surgeons involved in the study. Fourth, we have no available data regarding what a mentor may have pointed out in detail during the surgery, or rather, what factors may render the surgical outcome different before and after 21 HoLEP cases for beginner surgeons. However, these data are from retrospective studies conducted in teaching hospitals, implying that this study could potentially be undertaken in all institutions where HoLEP is performed. As such, the above stated limitations should be overcome in future prospective studies.
    In conclusion, we found that predictive factors for post-HoLEP incontinence had variations in their time course. Especially preoperative DO at the super-short period and patient age, surgeon mentorship, and prostate volume at 1 month after HoLEP, were the representative significant predictive factors identified during our 3-month follow-up duration. Additionally, preoperative DO and surgeon mentorship were representative significant factors for beginner surgeons, while only FDV age was a significant factor for experienced surgeons. These findings should be taken into account by surgeons, in particular beginners, to maximize the patient’s QoL with regards to urinary continence.

    NOTES

    Conflict of Interest
    No potential conflict of interest relevant to this article was reported.

    ACKNOWLEDGEMENTS

    We thank Dr. Takahiro Haraguchi for taking care of the patients.

    REFERENCES

    1. Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of the prostate: a size-independent new “gold standard”. Urology 2005;66(5 Suppl):108-13. crossref
    2. Cho KJ, Kim HS, Koh JS, Han SB, Kim SH, Kim HW, et al. Preoperative factors affecting postoperative early quality of life during the learning curve of holmium laser enucleation of the prostate. Int Neurourol J 2013;17:83-9. PMID: 23869273
    crossref pmid pmc
    3. Kelly DC, Das A. Holmium laser enucleation of the prostate technique for benign prostatic hyperplasia. Can J Urol 2012;19:6131-4. PMID: 22316518
    pmid
    4. Cho MC, Park JH, Jeong MS, Yi JS, Ku JH, Oh SJ, et al. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn 2011;30:1343-9. PMID: 21538499
    crossref pmid
    5. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2004;172(5 Pt 1):1926-9. PMID: 15540757
    crossref pmid
    6. Lerner LB, Tyson MD, Mendoza PJ. Stress incontinence during the learning curve of holmium laser enucleation of the prostate. J Endourol 2010;24:1655-8. PMID: 20645871
    crossref pmid
    7. Kim M, Lee HE, Oh SJ. Technical aspects of holmium laser enucleation of the prostate for benign prostatic hyperplasia. Korean J Urol 2013;54:570-9. PMID: 24044089
    crossref pmid pmc
    8. Kwon O, Lee HE, Bae J, Oh JK, Oh SJ. Effect of holmium laser enucleation of prostate on overactive bladder symptoms and urodynamic parameters: a prospective study. Urology 2014;83:581-5. PMID: 24373317
    crossref pmid
    9. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21:167-78. PMID: 11857671
    crossref pmid
    10. Cartwright R, Hashim H, Chapple C. What was “hot” at the ICS Annual Meeting San Francisco 2009. Neurourol Urodyn 2010;29:21-7. PMID: 20025018
    crossref pmid
    11. Brown DM, Wickham WE. The urethral pressure profile. Br J Urol 1969;51:211-7. crossref
    12. Haraguchi T, Takenaka A, Yamazaki T, Nakano Y, Miyake H, Tanaka K, et al. The relationship between the reproducibility of holmium laser enucleation of the prostate and prostate size over the learning curve. Prostate Cancer Prostatic Dis 2009;12:281-4. PMID: 19581921
    crossref pmid
    13. Aho T, Herrmann TR. Description of a modular mentorship programme for holmium laser enucleation of the prostate. World J Urol 2015;33:497-502. PMID: 25271105
    crossref pmid
    14. Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, et al. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 2006;50:569-73. PMID: 16704894
    crossref pmid
    15. Du C, Jin X, Bai F, Qiu Y. Holmium laser enucleation of the prostate: the safety, efficacy, and learning experience in China. J Endourol 2008;22:1031-6. PMID: 18377236
    crossref pmid
    16. Endo F, Shiga Y, Minagawa S, Iwabuchi T, Fujisaki A, Yashi M, et al. Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence. Urology 2010;76:1451-5. PMID: 20579706
    crossref pmid
    17. Shenoy SP, Marla PK, Suvarna R. Re: Endo et al.: Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence (Urology 2010;76:1451-1456). Urology 2011;77:1510 author reply 1510-1. PMID: 21624611
    crossref pmid
    18. Elmansy HM, Kotb A, Elhilali MM. Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate? J Urol 2011;186:1977-81. PMID: 21944135
    crossref pmid
    19. Bae J, Choo M, Park JH, Oh JK, Paick JS, Oh SJ. Holmium laser enucleation of prostate for benign prostatic hyperplasia: seoul national university hospital experience. Int Neurourol J 2011;15:29-34. PMID: 21468284
    crossref pmid pmc
    20. Shah HN, Mahajan AP, Hegde SS, Bansal MB. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int 2007;100:94-101. PMID: 17419697
    crossref pmid
    21. Jeong CW, Oh JK, Cho MC, Bae JB, Oh SJ. Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate. Int Braz J Urol 2012;38:362-71. PMID: 22765867
    crossref pmid
    22. Hwang JC, Park SM, Lee JB. Holmium laser enucleation of the prostate for benign prostatic hyperplasia: effectiveness, safety, and overcoming of the learning curve. Korean J Urol 2010;51:619-24. PMID: 20856646
    crossref pmid pmc
    23. Bruschini H, Simonetti R, Antunes AA, Srougi M. Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction. Int Braz J Urol 2011;37:380-6. PMID: 21756386
    crossref pmid

    Table 1.
    Patients’ characteristics (n=203)
    Characteristic Value
    Age (yr), median (range) 71 (34–90)
    Prostate volume (mL) 76.1±41.1
    Resected prostate weight (g) 52.9±35.3
    Surgical time (min) 172±63.4
    Enucleation time (min) 113±45.3
    Morcellation time (min) 29.6±28.4
    Surgeons, n (%)
     Performed by experienced 84 (41.4)
     Performed by beginners 119 (58.6)
    Prostate cancer, n (%) 16 (7.88)

    Values are presented as mean±standard deviation unless otherwise indicated.

    Table 2.
    Predictive factors for incontinence at the next day of catheter removal after HoLEP in all surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.038 0.997–1.080 0.067
    Preoperative IPSS 0.987 0.944–1.031 0.551
    Quality of life 0.992 0.687–1.434 0.968
    Operation time 1.007 1.003–1.012 0.002* 0.999 0.988–1.011 0.894
    Enucleation time 1.010 1.003–1.017 0.003* 1.009 0.995–1.023 0.216
    Morcellation time 1.008 0.997–1.018 0.141
    Mentorship 0.697 0.367–1.323 0.270
    Resected prostate weight 1.009 1.001–1.017 0.036* 0.997 0.972–1.022 0.815
    Prostate volume 1.007 1.000–1.014 0.049* 1.006 0.986–1.027 0.546
    MVP 1.007 1.000–1.014 0.067
    Compliance 0.990 0.980–1.000 0.056
    Detrusor overactivity 3.336 1.826–6.095 < 0.000* 3.375 1.790–6.363 0.000*
    Schafer 1.171 0.921–1.490 0.198
    First desire to void 0.998 0.994–1.002 0.419
    MCC 0.998 0.996–1.001 0.136
    Residual volume 1.000 0.997–1.002 0.899

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 3.
    Predictive factors for incontinence at 1 month after HoLEP in all surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.086 1.036–1.137 0.001* 1.072 1.023–1.124 0.004*
    Preoperative IPSS 0.975 0.932–1.021 0.281
    Quality of life 0.749 0.517–1.086 0.127
    Operation time 1.005 1.000–1.009 0.055
    Enucleation time 1.006 1.000–1.013 0.062
    Morcellation time 1.005 0.995–1.016 0.292
    Mentorship 0.225 0.095–0.534 0.001* 0.251 0.104–0.609 0.002*
    Resected prostate weight 1.008 1.000–1.016 0.057
    Prostate volume 1.008 1.001–1.015 0.024* 1.008 1.000–1.015 0.049*
    MVP 1.003 0.995–1.010 0.503
    Compliance 0.994 0.985–1.004 0.237
    Detrusor overactivity 1.055 0.582–1.910 0.861
    Schafer 1.027 0.809–1.303 0.829
    First desire to void 1.003 0.999–1.008 0.107
    MCC 1.001 0.998–1.003 0.637
    Residual volume 1.001 0.999–1.004 0.316

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 4.
    Predictive factors for incontinence at 3 months after HoLEP in all surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.053 0.996–1.114 0.071
    Preoperative IPSS 1.007 0.951–1.067 0.802
    Quality of life 0.943 0.594–1.497 0.803
    Operation time 1.003 0.997–1.009 0.291
    Enucleation time 1.001 0.992–1.010 0.849
    Morcellation time 1.004 0.991–1.016 0.581
    Mentorship 0.509 0.184–1.406 0.192
    Resected prostate weight 1.006 0.996–1.016 0.230
    Prostate volume 1.006 0.998–1.015 0.143
    MVP 0.996 0.986–1.006 0.407
    Compliance 0.997 0.984–1.010 0.681
    Detrusor overactivity 1.328 0.601–2.932 0.483
    Schafer 0.852 0.633–1.147 0.290
    First desire to void 1.005 1.000–1.010 0.047 1.004 0.992–1.016 0.516
    MCC 1.001 0.998–1.004 0.496
    Residual volume 1.001 0.998–1.004 0.393

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    Table 5.
    Predictive factors for incontinence at the next day of catheter removal after HoLEP in beginner surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.021 0.971–1.073 0.422
    Preoperative IPSS 0.933 0.879–0.990 0.022* 0.892 0.828–0.962 0.003*
    Quality of life 1.113 0.707–1.752 0.643
    Operation time 1.003 0.998–1.009 0.257
    Enucleation time 1.003 0.994–1.012 0.490
    Morcellation time 1.003 0.991–1.016 0.585
    Mentorship 0.642 0.305–1.350 0.243
    Resected prostate weight 1.006 0.995–1.018 0.273
    Prostate volume 1.005 0.994–1.015 0.396
    MVP 1.009 1.000–1.019 0.055
    Compliance 0.991 0.979–1.002 0.118
    Detrusor overactivity 3.561 1.568–8.089 0.002* 7.069 2.235–22.358 0.001*
    Schafer 1.291 0.922–1.807 0.137
    First desire to void 0.994 0.988–1.000 0.044 0.992 0.980–1.004 0.189
    MCC 0.996 0.992–0.999 0.019 1.000 0.993–1.007 0.961
    Residual volume 0.999 0.995–1.003 0.504

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 6.
    Predictive factors for incontinence at 1 month after HoLEP in beginner surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.099 1.028–1.174 0.005* 1.084 1.016–1.157 0.015*
    Preoperative IPSS 0.961 0.900–1.026 0.234
    Quality of life 0.818 0.515–1.299 0.395
    Operation time 1.004 0.998–1.011 0.169
    Enucleation time 1.007 0.997–1.016 0.172
    Morcellation time 1.001 0.988–1.014 0.855
    Mentorship 0.304 0.127–0.730 0.008* 0.358 0.145–0.883 0.026*
    Resected prostate weight 1.004 0.992–1.016 0.520
    Prostate volume 1.001 0.990–1.013 0.838
    MVP 0.999 0.989–1.009 0.880
    Compliance 0.995 0.984–1.007 0.404
    Detrusor overactivity 1.203 0.531–2.727 0.658
    Schafer 0.974 0.700–1.356 0.878
    First desire to void 1.000 0.994–1.006 0.926
    MCC 0.998 0.995–1.002 0.337
    Residual volume 1.000 0.996–1.005 0.852

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 7.
    Predictive factors for incontinence at 3 months after HoLEP in beginner surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.064 0.989–1.144 0.099
    Preoperative IPSS 0.906 0.828–0.991 0.031* 0.911 0.834–0.996 0.040*
    Quality of life 1.081 0.620–1.884 0.784
    Operation time 1.008 1.000–1.015 0.046 1.005 0.994–1.016 0.375
    Enucleation time 1.01 0.998–1.021 0.097
    Morcellation time 1.004 0.990–1.019 0.539
    Mentorship 0.573 0.210–1.559 0.276
    Resected prostate weight 1.005 0.991–1.019 0.499
    Prostate volume 1.002 0.988–1.016 0.767
    MVP 1.001 0.989–1.013 0.859
    Compliance 1.000 0.989–1.011 0.981
    Detrusor overactivity 1.071 0.401–2.862 0.891
    Schafer 1.090 0.736–1.614 0.668
    First desire to void 1.003 0.996–1.009 0.433
    MCC 1.002 0.998–1.006 0.454
    Residual volume 1.003 0.998–1.008 0.220

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 8.
    Predictive factors for incontinence at the next day of catheter removal after HoLEP in experienced surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 1.067 0.999–1.139 0.053
    Preoperative IPSS 0.995 0.925–1.072 0.905
    Quality of life 0.775 0.405–1.484 0.442
    Operation time 1.016 1.007–1.025 0.001* 1.004 0.987–1.022 0.625
    Enucleation time 1.023 1.011–1.036 0.000* 1.017 0.994–1.041 0.152
    Morcellation time 1.017 0.999–1.036 0.071
    Mentorship 0.6 0.425–1.024 0.979
    Resected prostate weight 1.011 0.999–1.023 0.062
    Prostate volume 1.009 1.000–1.019 0.060
    MVP 1.003 0.991–1.015 0.612
    Compliance 0.988 0.968–1.008 0.242
    Detrusor overactivity 3.208 1.288–7.992 0.012* 2.624 0.964–7.138 0.059
    Schafer 1.052 0.743–1.487 0.776
    First desire to void 1.004 0.997–1.010 0.236
    MCC 1 0.997–1.004 0.773
    Residual volume 1 0.998–1.003 0.747

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 9.
    Predictive factors for incontinence at 1 month after HoLEP in experienced surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 0.990 0.930–1.053 0.741
    Preoperative IPSS 1.017 0.948–1.092 0.632
    Quality of life 1.173 0.623–2.210 0.621
    Operation time 1.000 0.993–1.008 0.926
    Enucleation time 1.004 0.994–1.014 0.416
    Morcellation time 0.992 0.972–1.013 0.465
    Mentorship 0.733 0.468–1.149 0.979
    Resected prostate weight 0.995 0.984–1.007 0.454
    Prostate volume 0.997 0.987–1.007 0.528
    MVP 1.006 0.994–1.019 0.320
    Compliance 1.005 0.987–1.023 0.578
    Detrusor overactivity 1.705 0.692–4.204 0.246
    Schafer 1.098 0.771–1.562 0.605
    First desire to void 1.009 1.002–1.017 0.012*
    MCC 1.002 0.999–1.005 0.243
    Residual volume 1.000 0.997–1.003 0.877

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.

    * P<0.05, statistical significance.

    Table 10.
    Predictive factors for incontinence at 3 months after HoLEP in experienced surgeons
    Variable Univariate
    Multivariate
    Odds ratio 95% CI P-value Odds ratio 95% CI P-value
    Age 0.956 0.873–1.048 0.335
    Preoperative IPSS 0.977 0.881–1.083 0.658
    Quality of life 1.261 0.485–3.280 0.634
    Operation time 0.990 0.977–1.003 0.123
    Enucleation time 0.984 0.966–1.003 0.096
    Morcellation time 0.994 0.965–1.025 0.709
    Mentorship 0.167 0.088–0.316 0.981
    Resected prostate weight 0.991 0.971–1.011 0.372
    Prostate volume 0.994 0.977–1.010 0.451
    MVP 0.988 0.969–1.007 0.216
    Compliance 1.003 0.979–1.027 0.795
    Detrusor overactivity 0.968 0.269–3.482 0.960
    Schafer 0.718 0.427–1.208 0.212
    First desire to void 0.995 0.985–1.005 0.343
    MCC 0.995 0.989–1.002 0.166
    Residual volume 0.996 0.990–1.003 0.300

    HoLEP, holmium laser enucleation of the prostate; CI, confidence interval; IPSS, International Prostate Symptom Score; MVP, maximum voiding pressure; MCC, maximum cystometric capacity.



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