Modified early apical release vs. non-early apical release in holmium laser prostatic enucleation: Impact on stress urinary incontinence.

Background: We aimed to compare the incidence of de novo stress urinary incontinence (SUI) of two apical release techniques for holmium laser prostatic enucleation (HoLEP)s: modified early apical release (EAR) and non-early apical release (non-EAR).

Methods: We conducted a retrospective database review analyzing the records of patients who underwent holmium laser enucleation of the prostate with the modified EAR and non-EAR techniques for symptomatic benign prostatic hyperplasia. The study period spanned from January 2012 to December 2021 in a single center. Patients' demographics, perioperative data, and functional and technical outcomes were compared between both techniques.

Results: The study included a total of 786 patients; 556 patients underwent the non-EAR technique (group I), and 230 underwent the modified EAR technique (group II). The mean enucleated prostate weight in group I was 68.2±45.6 g compared to 93.3±51.9 g in group II (p< 0.001). De novo SUI within a month of surgery was reported in 34 cases (6.1%) in group I compared to eight cases (3.5%) in group II. The percentage of patients with persistent SUI at one year postoperatively dropped to 2.7% and 0.9% in the non-EAR and modified EAR groups, respectively. Moreover, persistent SUI after one year from surgery was reported in 1.4 % of the non-EAR group compared to 0.44% in the modified EAR group. Multivariate regression analysis demonstrated that age >70 years (p=0.06), operative time >90 minutes (p=0.011), and the non-EAR technique (p=0.004) were significantly associated with the onset of postoperative de novo SUI.

Conclusions: Our research indicates that both modified EAR and non-EAR techniques employed during HoLEP yield comparable efficacy and safety outcomes. Nonetheless, the modified EAR technique is associated with reduced postoperative de novo SUI.