Incidence and predictors of urinary incontinence rates after thulium fiber laser enucleation of prostate performed by single surgeon.

Purpose: We aimed to evaluate the predictive clinical and operative risk factors for urinary incontinence (UI) rates following thulium fiber enucleation of benign prostate hyperplasia (ThuFLEP). Materials and methods: We conducted a retrospective cohort review of a prospectively maintained database for patients who underwent ThuFLEP between 2021 and 2023 in our university clinic performed by a single surgeon with high experience (more than 3000 endoscopic enucleation). To perform the operation, we used a thulium fiber laser Fiberlase U3 (IRE Polus ltd, Fryazino, Russia) with operating modes of 1.5 J and 40 Hz 60 W. Postoperative UI rates and risk factors following ThuFLEP were assessed for three follow-up intervals (up to 1 months, from 1 to 3 months and after 3 months post-ThuFLEP). Statistical analysis was conducted using univariate and multivariate logistic regression. Results: Out of total 578 patients who underwent ThuFLEP, the study included 381 patients with full information about continence status. Long-term UI (more than 3 months) were found only in 1.6% cases with 0.8% for stress UI, 0.3% for urge UI and 0.5% for mixed UI. Univariate logistic regression analysis has shown that higher total laser energy (OR = 1.009; 95% CI = 1.001-1.018; Conclusion: Short-term UI up to 3 months following ThuFLEP is associated with early sphincter release, while overall UI rates are related with enucleation technique (preferable En-bloc) and total laser energy (preferable lower energy). The surgeon should take all these risk factors into account before choosing the technique of BPH surgical treatment.