Transient and persistent urinary incontinence after thulium fiber laser enucleation of the prostate (ThuFLEP): long-term trends and predictive factors in a real-world cohort.

PURPOSE: To evaluate the incidence and predictive factors of transient and persistent urinary incontinence following ThuFLEP.

METHODS

We included consecutive patients who underwent ThuFLEP between March 2023 and July 2024. The primary endpoint was transient urinary incontinence at 3 months. Secondary outcomes included stress urinary incontinence(SUI), urge urinary incontinence(UUI), and persistent incontinence at 12 months. Uni- and multivariate logistic regression analyses were performed to identify predictors of 3-month incontinence.

RESULTS

A total of 213 patients were included(mean age 71.9 ± 8.1years; mean prostate volume 93.3 ± 33.9 cc). Mean operative time was 96.1 ± 44.0 minutes, and mean total laser energy delivered was 94.6 ± 38.6 kJ. At 3months, overall urinary incontinence was reported in 44 patients (20.7%), including SUI in 9.9%, UUI in 8.0%, and mixed incontinence in 2.8%. At 12months, overall incontinence significantly decreased to 6.6%(p < 0.01), with persistent SUI and UUI rates of 2.3% each. Multivariate analysis identifiedtotal laser energy as an independent predictor of transient urinary incontinence (OR 1.015 per kJ, 95% CI 1.002-1.03, p = 0.025). Prostate volume,enucleation technique and surgeon experience were not independently associated with incontinence."

CONCLUSIONS

ThuFLEP was associated with favorable long-term continence outcomes, with most postoperative urinary incontinence being transient and resolving within 12 months. Higher laser energy delivery is an independent and potentially modifiable predictor of early urinary incontinence. Optimization of energy use and surgical technique, particularly during the learning curve, may improve early functional recovery after ThuFLEP.