[Urinary incontinence after endoscopic enucleation of the prostate with the Holmium laser: Evolutionary aspects and associated predictive factors]. / Incontinence urinaire post énucléation endoscopique de la prostate au laser Holmium : aspects évolutifs et facteurs prédictifs associés.

OBJECTIVE: To study the evolutionary aspects of stress urinary incontinence and urinary incontinence by urgency after HoLEP through a series of 200 consecutive cases of the same surgeon then to seek secondarily the predictive factors of occurrence in the service of urology of the Hospital Center of Martigues. PATIENTS AND METHODS: This was a monocentric, retrospective, descriptive and analytical study conducted in the urology department of the Martigues Hospital. All patients who were treated with HoLEP for benign prostatic hypertrophy (BPH) between September 2017 and March 2021 were included in the study. Patients with an age greater than 75 years, obese (BMI>30) or with neurological disease were excluded from this study. RESULTS: Between September 2017 and March 2021, 204 patients were included in our study. The average urinary incontinence rate was 21.2% 12.2% 7.4% and 2.7% at 1 month, 3 months, 6 months and 12 months respectively. The rate of stress urinary incontinence was 5.4%, 9.2%, 5.6% and 1.8% at 1 month, 3 months, 6 months and 12 months post HoLEP respectively. Urge urinary incontinence was estimated at 13.3%, 3%, 1.8% and 0.9% at M1, M3, M6 and M12 post-HoLEP respectively. Preoperative erectile dysfunction, delivered energy, enucleated prostate weight and total intraoperative time were statistically associated with the occurrence of stress urinary incontinence postoperatively. The operative time and a low operative Qmax were statistically associated with the occurrence of postoperative stress urinary incontinence. CONCLUSION: HoLEP is at risk of postoperative urinary incontinence. Preoperative information of the patients on the risk of urinary incontinence is essential.

Single use and reusable flexible ureteroscopies for the treatment of urinary stones: A comparative study of perioperative complications.

OBJECTIVE: To compare the perioperative complications of patients who underwent flexible ureteroscopy (fURS) for the treatment of urinary stones according to the type of ureteroscope used, single-use (suURS) or reusable (rURS) flexible ureteroscope. PATIENTS AND METHODS: A retrospective and single-center study was conducted between January 2017 and May 2019, including all fURS performed for nephrolithiasis management. During the study period, 5rURS and 1suURS (UscopePU3022™) were available. The primary endpoint was the occurrence of 30-days postoperative complications, especially infectious complications, classified according to Clavien-Dindo grading system. RESULTS: Overall, 322 consecutive fURS were included corresponding to 186 rURS (57.8%) and 136 suURS (42.2%). Respectively in rURS and suURS groups, the median (IQR) age was 57 (45-65) vs. 57 (44-66) years (P=0.75), 83 (44.6%) vs. 63 (46.3%) female were included (P=0.82), and median (IQR) Charlson score was 2 (1-3) vs. 2 (0-3) (P=0.15). Fifty-one patients (15.8%) developed postoperative complications, 28 patients (15%) in rURS group and 23 patients (17.6%) in suURS group (P=0.64). Most of them (n=47, 92.1% of overall complications) were minor (Clavien I-II). Occurrence of urinary tract infection in suURS group (n=13; 9.5%) was equally comparable with rURS group (n=10; 5.4%), P=0.15. CONCLUSIONS: Our data suggests that suURS represents a safe alternative to rURS. Compared to reusable devices, UscopePU3022™ use was associated with a similar complication rates, however, did not decrease the occurrence of infectious events. LEVEL OF EVIDENCE: 3.