Anterior Fibromuscular Stroma-Preserving Anteroposterior Dissection HoLEP Reduces Day-1 Incontinence: A Retrospective Cohort Study.

OBJECTIVES

To determine whether anterior fibromuscular stroma (AFS) preservation within an anteroposterior (AP) HoLEP platform independently reduces ultra-early postoperative incontinence.

METHODS

We retrospectively analyzed consecutive HoLEP cases (April 2019-June 2025) performed by a single surgeon. Of 719 procedures, 272 consecutive cases using a standardized AP platform were included and classified into conventional AP-HoLEP (CON, n = 60), mucosal incision-first AP-HoLEP (MI, n = 180), and AFS-preserving AP-HoLEP (AFS, n = 32). The primary endpoint was Day-1 incontinence, defined as any objective leakage (> 0 mL) within 24 h after catheter removal on Postoperative Day 2. Multivariable logistic regression was used to identify independent predictors.

RESULTS

Day-1 incontinence occurred in 55% (33/60) of CON, 58% (104/180) of MI, and 25% (8/32) of AFS cases (p = 0.003). In multivariable analysis, AFS preservation was independently associated with lower odds of Day-1 incontinence versus CON (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.11-0.80; p = 0.016), whereas MI was not (OR, 1.14; 95% CI, 0.62-2.11; p = 0.680). Perioperative safety outcomes were comparable, with low rates of Clavien-Dindo ≥ III events.

CONCLUSIONS

Within an AP-HoLEP platform, AFS preservation was associated with improved Day-1 continence without compromising safety, supporting ventral-support preservation as a key lever for ultra-early continence recovery.