Holmium laser enucleation of the prostate (HoLEP) is one minimally invasive surgical intervention for severe benign prostatic hyperplasia. This procedure has demonstrated decreased post-operative complications, improved post-operative Qmax, and decreased catheter time in comparison to standard transurethral resection of the prostate (TURP). Side effects after surgery include temporary hematuria, retrograde ejaculation, as well as urinary incontinence. Surgical intervention after TURP is well-described in the literature; however there is paucity of data describing the use of artificial urinary sphincter (AUS) and slings after HoLEP. We aimed to review cases completed at our institution to better describe the use of AUS and sling after HoLEP.

A retrospective chart review was completed of HoLEP patients that underwent AUS or sling placement at our institution from 2009 to 2019.  Baseline characteristics included type of incontinence procedure, use of conservative therapy, AUA symptom score. Post-surgical outcomes included postoperative retention, continence status, and need for further procedures.

Twenty men underwent HoLEP at our institution from 2009 to 2019 that also underwent AUS or sling placement. The mean follow up was 12.9 months (IQR 1-55 months). Patient demographic characteristics included a mean age of 75, median ASA of 2, and median BMI of 29.3 kg/m2. Median pre-operative prostate size was 97.3 grams and median tissue resected was 51.18 grams. Ten (50%) patients underwent AUS and ten (50%) patients underwent sling placement. Four (40%) patients that underwent sling placement had postoperative urinary retention requiring temporary Foley catheter placement. Four (20%) patients required further procedures, which included pump revision (n=2), repeat incontinence procedure (n=1), and intravesical Botox administration (n=1). There was no evidence of postoperative hematoma or infection. Median change in pads per day preoperatively and postoperatively was 3.6 and 1, respectively.

Based upon the study results, AUS and sling placement are successful options in men suffering from urinary incontinence after HoLEP. In this study there was a total of four cases which required additional surgical procedures, and only one of these patients required an additional procedure for persistent incontinence.

In this study we evaluated our experience in twenty men who underwent AUS or sling placement after HoLEP. These procedures were completed with acceptable perioperative outcomes and success rates. This series demonstrates that men suffering from urinary incontinence after HoLEP can successfully undergo AUS or sling placement with low likelihood of requiring further procedures. Additional studies with greater long-term follow up are required to better demonstrate the long term efficacy of these procedures in this patient population.