Meta-analysis of postoperative urinary incontinence incidence and risk factors in HoLEP

Objective: To systematically identify and quantify the incidence and risk factors of postoperative urinary incontinence (UI) in holmium laser enucleation of the prostate (HoLEP), aiming to provide a basis for intervention strategies. Methods: Relevant studies on postoperative UI in HoLEP were searched in databases including PubMed, Web of Science, EMBase, CNKI, Wanfang Data Knowledge Service Platform, VIP and CBMdisc, with the search period up to April 2024. Titles, abstracts and full texts were screened using the Endnote application. Studies meeting the inclusion and exclusion criteria underwent quality assessment and data extraction. The incidence of postoperative UI and/or adjusted or unadjusted odds ratios (OR), relative risks or ratios were recorded, and analysis was conducted using Stata 15.0 software. Results: A total of 17 studies encompassing 7939 patients were included. The pooled incidence of UI after HoLEP was 1.12, 95% CI (1.11–1.13); the 3-month postoperative incidence was 1.06, 95% CI (1.05–1.06); the 6-month postoperative incidence was 1.04, 95% CI (1.03–1.05); the 12-month postoperative incidence was 1.05, 95% CI (1.03–1.06); and the incidence of permanent UI after HoLEP was 1.01, 95% CI (1.00–1.01). The occurrence of UI after HoLEP exhibited a time-dependent variation. The risk factors for UI after HoLEP included the following: age (OR = 1.03, 95% CI: 1.01–1.06); body mass index (BMI; OR = 1.10, 95% CI: 1.01–1.20); prostate volume (OR = 1.77, 95% CI: 1.39–2.27); prostate-specific antigen (PSA) (OR = 0.98, 95% CI: 0.87–0.92); International Prostate Symptom Score (IPSS) (OR = 0.94, 95% CI: 0.83–1.07). Conclusion: The results of this study indicate a decreasing trend in the incidence of postoperative UI after HoLEP over time, with a time-dependent change. Age, BMI, prostate volume, PSA and IPSS are risk factors for postoperative UI after HoLEP. Age and prostate volume have a significant impact on UI. Therefore, preoperative assessment and intervention for these factors are crucial in reducing the occurrence of postoperative UI in HoLEP.