The Impact of Standard vs Early Apical Release HoLEP Technique on Postoperative Incontinence and Quality of Life

Objectives To investigate the difference in postoperative incontinence and quality of life comparing standard vs early apical release (EAR) Holmium Laser Enucleation of the Prostate (HoLEP). Methods A retrospective review was performed to identify patients who underwent HoLEP from December 2021 to December 2022 at a single teritary referral center with two participating consultant urologists. Patients were assessed with questionnaires and evaluated clinically. We performed propensity score matching with a logistic regression and a 1:1 matching method. A propensity score adjusted logistic regression (PSRM) was performed to compare the pads per day between surgical techniques controlling for age, prostate size, preoperative survey data, uroflow and post void residual. Results 114 patients underwent HoLEP, of which 60 patients were treated with EAR and 54 patients with standard technique. EAR technique demonstrated shorter operative times (p= 0.046). The EAR cohort demonstrated improved AUASS (p = 0.034, p= 0.001), QOL (p= 0.001, p<0.001), and continence rates (p<0.001, p<0.001) at 6 and 12 weeks postoperatively. PSRM showed that the standard HoLEP increased the risk of requiring >2 pads per day 4.2x (p= 0.031, HR 95%, CI = 1.16, 15.35) and 8.3x (p<0.001, HR 95% CI 3.17, 21.6) at 6 and 12 weeks postoperatively. Conclusions Early apical release technique promoted earlier return of continence and improved quality of life within 6 weeks of surgery. Data Availability The data demonstrating the study’s results is accessible from the corresponding author in an anonymized format upon reasonable request for the purpose of review.