ArticleWorld journal of urology2025
Applied trigonometry in elucidating the mechanism of post-HoLEP urinary incontinence.
Article in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Radial force and Post-HoLEP incontinence: is the external sphincter the real victim, or is it the anterior fibromuscular stroma?World journal of urology · 2026Article
- Does pulse modulation technology improve endoscopic enucleation of the prostate? Real-world comparison of three contemporary laser platforms in 447 patients.World journal of urology · 2026Observational
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12 authors.
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Abstract
purposeStress urinary incontinence (SUI) after holmium laser enucleation of the prostate (HoLEP) is traditionally explained by longitudinal overstretching of the external urethral sphincter (EUS) during enucleation. We propose extreme radial forces exerted on the EUS as a novel mechanism for post-HoLEP SUI.
methodsWe assessed the resectoscope angles during enucleation as seen on external intraoperative pictures followed by fluoroscopically calibrated measurements and trigonometric calculations of EUS dilation as a function of the resectoscope angle and diameter and the membranous urethra length and width. Preoperative magnetic resonance imaging studies (n = 55) validated the trigonometric formula relative to SUI at one month post-HoLEP.
resultsThe maximal median angles for the non-SUI (n = 28) and SUI (n = 27) groups were 54° vs. 57° (p = 0.002), and the calculated sphincter dilations were 39mm vs. 49mm (p < 0.001), respectively. The sphincter dilation and resectoscope angle were the only independent predictors of SUI post-HoLEP in the univariate and multivariate regression models. A receiver-operating characteristic analysis found an area under the curve (AUC) of 0.849 for our formula, 0.764 for sphincter dilation, and 0.745 for the resectoscope angle. These AUCs were significantly better than those for prostate volume and patient age (p < 0.05).
conclusionsThe EUS dilation caused by radial forces exercised during resectoscope angulation is a plausible cause for post-HoLEP UI. It may also explain its temporality.
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