Practice patterns in the evaluation and management of urinary incontinence following anatomic endoscopic enucleation of the prostate (AEEP): results from a global survey.

PURPOSE: To assess global practice patterns in the evaluation and management of urinary incontinence (UI) following Anatomical Endoscopic Enucleation of the Prostate (AEEP), a procedure increasingly used to treat benign prostatic hyperplasia. MATERIALS AND

METHODS

A comprehensive 40-question web-based survey was distributed globally to practicing urologists with experience in AEEP. The survey captured information on surgeon demographics, surgical techniques, postoperative care, diagnostic approaches, treatment strategies, and patient counseling. Data collection occurred between April 21 and May 10, 2025. Descriptive and comparative statistical analyses were performed to identify trends and associations. REUSLTS: A total of 97 valid responses were analyzed, with the majority of respondents based in North America (36%), Europe (34%), and Asia (10.3%). Most had 1–5 years of AEEP experience (51.5%) and performed over 200 procedures (43.3%). Holmium laser was the most common energy source (65.9%), and 57.7% preferred en bloc enucleation. Urge incontinence (56.7%) was most prevalent, followed by mixed (43.3%) and stress incontinence (33%). First-line treatment for UI included pelvic floor muscle training (68%), with pharmacological management using anticholinergics primarily for urge UI. Surgical intervention was typically reserved for persistent symptoms beyond 6 months. Notably, 79.4% of respondents practiced apical mucosal preservation.

CONCLUSIONS

This global survey reveals significant variability in post-AEEP incontinence management, driven by differences in experience, resources, patient demographics, and regional practices. Although conservative treatment predominates, structured preoperative and postoperative protocols- including early pelvic floor training and judicious use of diagnostics- are underutilized. These findings underscore the need for evidence-based guidelines to optimize outcomes and reduce the burden of post-AEEP incontinence.