Predictive factors of stress urinary incontinence after Holmium Laser Enucleation of the Prostate: a magnetic resonance imaging-based retrospective study.

Background: Stress urinary incontinence (SUI) remains a prevalent complication after Holmium Laser Enucleation of the Prostate (HoLEP). This retrospective analysis aims to delineate perioperative and anatomical determinants of SUI as observed on preoperative multiparametric magnetic resonance imaging (mpMRI) in patients subjected to HoLEP. Methods: We reviewed 216 benign prostatic hyperplasia (BPH) cases managed via HoLEP by a singular urologist at Sun Yat-sen Memorial Hospital from January 2021 to September 2022. Comprehensive medical documentation, including age, body mass index (BMI), prostate volume (PV), total prostate-specific antigen (tPSA), and perioperative variables: operative time (OT), enucleated prostate volume (EPV), were assessed. Detailed analyses of preoperative prostate mpMRI scans were conducted to measure factors such as thickness of the posterior wall of the membranous urethral sphincter (TPWMUS), membranous urethral length (MUL), membranous urethral volume (MUV), and prostatic apex morphology. Results: The cohort encompassed 216 participants, among whom 45 (20.83%) experienced SUI subsequent to one month of HoLEP therapy. At three months, 23 individuals exhibited recovery, reducing the prevalence of SUI to 10.19%. By the six-month milestone, the incidence further declined to 1.38%, with 19 patients reporting normalization of continence. Binary logistic regression analysis identified OT, TPWMUS, and prostatic apex and membranous urethral overlap (PAOMU) emerged as independent risk factors for SUI, while MUV was identified as a protective factor. Conclusions: The risk of SUI post-HoLEP is significantly associated with OT, TPWMUS, and PAOMU, while MUV imparting a protective effect.