Holmium laser enucleation of the prostate (HoLEP) is a commonly performed procedure for treatment of symptomatic benign prostatic hyperplasia (BPH). Long-term urinary incontinence after holmium laser enucleation of the prostate is a rare but can be debilitating complication to patients. The rates of occurrence and management are not well documented in the literature. The purpose of this study was to determine the incidence and management of long-term urinary incontinence after HoLEP.

A retrospective review, from an IRB approved database, of 515 patients that underwent a HoLEP at our institution between January 2012 and December 2017 was performed. Long-term urinary incontinence after HoLEP was defined as any leakage of urine lasting longer than 3 months post-operative date. Patients were seen for follow-up at 2 weeks, 6 weeks, 3 months, 6 months post-operative date. Patient data on rates of stress and urge urinary incontinence were collected with the addition to potential neurological causes, treatment methods, and demographic data. Univariate analysis was performed for demographics and baseline characteristics.

Of the 515 patients, 8 (1.6%) had long-term urinary incontinence after HoLEP (Table 1). Urge urinary incontinence occurred in 3 (0.6%) patients, and stress urinary incontinence (SUI) occurred in 5 patients (1.0%). Patients with urinary urge incontinence (UUI) that failed medical therapy were treated with intra-detrusor botox injections of the bladder. Patients with SUI that failed initial pelvic floor physiotherapy then received peri-urethral bulking agent as the management for their SUI. All SUI patients noted some improvement after peri-urethral bulking agent. Two SUI patients required repeat injection at 7 and 8 months after their initial treatment for SUI. Five patients with long-term urinary incontinence had additional neurologic comorbidities including Parkinson’s disease (1), myasthenia gravis (1), multiple sclerosis (1), and debilitating spinal stenosis (2).

Although rare, long-term urinary urge and stress incontinence are potential complications that can occur post holmium laser enucleation of the prostate. Intra-detrusor Botox injection and peri-urethral bulking agents can be used to treat urge and stress incontinence complications, respectively.  In addition, patients with underlying neurologic disease have an increased risk of long-term urinary incontinence and should be advised accordingly.

Patients with long-term urinary incontinence as a complication of holmium laser enucleation of the prostate need to be managed and counseled differently than patients without these complications.