MP20-14 Can post-HoLEP urinary incontinence be predicted by the endoscopic aspect of membranous urethra mucosa at the end of the procedure? – A prospective AI based video analysis

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP20)1 May 2024MP20-14 Can post-HoLEP urinary incontinence be predicted by the endoscopic aspect of membranous urethra mucosa at the end of the procedure? – A prospective AI based video analysis Tomer Mendelson, Ziv Savin, Ron Marom, Yotam Veredgorn, Amihay Nevo, Ofer Yossepowitch, and Mario Sofer Tomer MendelsonTomer Mendelson , Ziv SavinZiv Savin , Ron MaromRon Marom , Yotam VeredgornYotam Veredgorn , Amihay NevoAmihay Nevo , Ofer YossepowitchOfer Yossepowitch , and Mario SoferMario Sofer View All Author Informationhttps://doi.org/10.1097/01.JU.0001008732.80104.31.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative urinary incontinence (UI) is a transient side effect of holmium laser enucleation of the prostate (HoLEP), ranging 15-27%. The common hypothesis is that UI is caused by damage of the external urethral sphincter (EUS). Integrity of mucosal membranous urethra circumference (MMUC) distal to verumontanum at the completion of HoLEP is traditionally considered a marker of EUS preservation and a prognosticator of maintaining postoperative continence. We aimed to assess the reliability of endoscopic identification and interpretation of the post-HoLEP MMUC integrity and its influence on the functional outcome. METHODS: A prospective cohort of 40 HoLEPs operated by a single dedicated surgeon was recorded by a video platform able to divide the surgical steps using AI (Theator, Palo Alto, Ca). MMUC images at completion of HoLEP were analyzed by the surgeon (as a referent) and another HoLEP expert as well as by 2 residents, all of them blinded to the clinical outcome. Findings were scaled as 0=non-damage, 1=anterior damage and 2=lateral damage. The results were statistically analyzed for inter-observer agreement and association with post-HoLEP UI 1 month after surgery. UI was defined as any drop on a ped as reported by the patient. RESULTS: The referent rated the MMUC condition as 71%, 23% and 6% for grades 0, 1 and 2, respectively. However, the overall inter-observer agreement was K=0.28, inter-experts agreement was K=0.13 and inter-residents agreement was K=0.39. These results reveal a low inter-observer reliability. The rate of UI by our strict definition was 27% at 1 month. Univariate analysis showed no association between the grade of MMUC injury and UI (OR 0.34, 95%CI 0.043 - 3.08). Multivariate analysis controlling for age, prostate size, resectoscope size (22 vs 26 FR), surgery time, and use of final fulguration did not show any statistically independent predictor. CONCLUSIONS: It appears that contrary to the traditional perception, the endoscopic assessment of MMUC as a marker of EUS location, function and injury is not reliable. To the best of our knowledge, despite a dogmatic acceptance, there is no high level of evidence in literature to support the significance of MMUC integrity. Further studies, including real time electro-physiological, anatomical and functional assessment, are needed to better understand the mechanism of post-HoLEP UI. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e325 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Tomer Mendelson More articles by this author Ziv Savin More articles by this author Ron Marom More articles by this author Yotam Veredgorn More articles by this author Amihay Nevo More articles by this author Ofer Yossepowitch More articles by this author Mario Sofer More articles by this author Expand All Advertisement PDF downloadLoading ...