Persistent Incontinence Rates and Incontinence Surgeries Are Low after Holmium Laser Enucleation of the Prostate: A Retrospective Analysis of a Large National Claims Database

Purpose: Data on complications following holmium laser enucleation of the prostrate (HoLEP) are primarily single-center experiences. Although postoperative urethral stricture rates are well described in the literature, secondary urinary incontinence surgeries (UIS) are poorly characterized. We aimed to quantify the incidence of long-term complications, notably UIS, following HoLEP using a large national dataset. Methods: We retrospectively reviewed a limited dataset from the TriNetX Research Network Database, which carries clinical data of 104 US academic medical centers and health care organizations. A search query between 1 year prior to and 2 years after HoLEP identified patients of interest from 45 providers. The following diagnoses and procedures were queried: HoLEP, urinary incontinence, anti-spasmodic prescription, artificial urethral sphincter (AUS), male sling, cystourethroscopy with injection for chemodenervation, injection of urethral bulking material, meatotomy/meatoplasty, urethrotomy, transurethral resection of bladder neck contracture, urethroplasty, and urinary retention. Results: Of the 11,559 patients that underwent HoLEP, 2391 (20.7%) were diagnosed with urinary incontinence, and 1921 (16.6%) were prescribed urinary antispasmodics in the year preceding the surgical procedure. The risk of short-term incontinence in the first 3 months following the surgical procedure was 1185 (10.3%). This decreased to 551 (4.8%) between 1 and 2 years after the surgical procedure. Thirteen (0.1%) underwent insertion of an AUS or sling placement, 90 (0.8%) had cystoscopy with chemodenervation, and 10 (0.10%) underwent urethral bulking in the 2 years following HoLEP. The same dataset shows 209 (1.8%) patients required surgical treatment of postoperative urethral stricture disease, excluding bladder neck contracture, in the 24 months following HoLEP. Conclusion: Data from a large national database show a low rate (4.8%) of persistent urinary incontinence beyond 1 year following HoLEP and an expected low rate of urinary incontinence procedures.