Modified early apical release vs. non-early apical release in holmium laser prostatic enucleation

Impact on stress urinary incontinence

Authors

  • Abdulghani Khogeer King Abdulaziz University
  • Adel Elatreisy Al-Azhar university, Cairo
  • Ahmed S. Zugail King Abdulaziz University
  • Yousef Almehmadi King Abdulaziz University
  • Ahmed Ibrahim McGill University Health Center
  • Serge Carrier McGill University Health Center
  • Mélanie Aubé-Peterkin McGill University Health Center

DOI:

https://doi.org/10.5489/cuaj.9099

Keywords:

Prostate hyperplasia, BPH, Holmium, Laser, Enucleation, HoLEP, Urinary incontinence

Abstract

INTRODUCTION: We aimed to compare the incidence of de novo stress urinary incontinence (SUI) of two apical release techniques for holmium laser prostatic enucleation (HoLEP): 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 HoLEP 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. Patient demographics, perioperative data, and functional and technical outcomes were compared between the techniques.

RESULTS: The study included a total of 786 patients; 556 patients underwent the non-EAR technique (group 1), and 230 underwent the modified EAR technique (group 2). The mean enucleated prostate weight in group 1 was 68.2±45.6 g compared to 93.3±51.9 g in group 2 (p<0.001). De novo SUI within a month of surgery was reported in 34 cases (6.1%) in group 1 compared to eight cases (3.5%) in group 2. 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.

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Published

2025-04-17

How to Cite

Khogeer, A., Elatreisy, A., Zugail, A. S., Almehmadi, Y., Ibrahim, A., Carrier, S., & Aubé-Peterkin, M. (2025). Modified early apical release vs. non-early apical release in holmium laser prostatic enucleation: Impact on stress urinary incontinence. Canadian Urological Association Journal, 19(8), 242–8. https://doi.org/10.5489/cuaj.9099

Issue

Vol. 19 No. 8 (2025): CUAJ August

Section

Original Research

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