Incidence and predictors of urinary incontinence rates post-holmium laser enucleation of prostate.

INTRODUCTION: One of the main adverse outcomes following Holmium laser enucleation of the prostate (HoLEP) is the development of transient de novo urinary incontinence (UI). We aimed to evaluate the correlation of multiple risk factors to UI rates post-HoLEP. METHODS: A review of prospectively maintained 7 year database for HoLEP patients in a single center was performed. UI data at 6 week, 3 month, and 1 year follow-up intervals were assessed with bivariate and multivariate analysis of multiple potential risk factors. RESULTS: The study included 666 patients with median (IQR) age of 72 (66-78) years old and median (IQR) preoperative prostate volume of 89 (68-126) gm. UI was seen in 287 (43%), 100 (15%) and 26 (5.8%) at 6 week, 3 month, and 1 year follow up occasions respectively. At 6 weeks follow up, UI type was stress, urge and mixed in 121 (18.16%), 118 (17.72) and 48 (7.21%) patients respectively. Using a multivariate regression analysis, obesity and pre-operative UI were associated with postoperative UI rate at both 6 week (p = .0065, .031) and 3 month (p = .0261, .044) follow up encounters respectively. Also, larger specimen weight was another predictor for 6 week UI (p = .0399) while higher frailty score was a predictor for UI at 3 month occasion (p = .041). CONCLUSION: Patients with preoperative UI, obesity, frailty, and large prostate volume are at higher risk of short-term UI post-HoLEP up to 3 months. Patients with one or more of these risk factors should be counseled regarding the higher risk of UI.

Holmium laser enucleation of the prostate in patients with preexisting inflatable penile prostheses.

This retrospective study evaluated the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) in patients with an inflatable penile prosthesis (IPP). Five men with a preexisting IPP underwent HoLEP for obstructive lower urinary tract symptoms at Baylor Scott and White Medical Center between January 2016 and September 2020. None of the patients had preexisting prostate malignancy or urethral strictures. Minimal blood loss was seen during HoLEP, with an average length of hospital stay of 1.4 days and an average time of catheterization of 1.4 days. None of the patients had any known postoperative complications, including need for transfusions, return to the operating room for postoperative bleeding, or clot evacuation. In conclusion, there was no increased risk of perioperative or postoperative complications for HoLEP in this group compared with the general population. HoLEP appears to be a safe and efficacious method for the treatment of lower urinary tract symptoms in patients with a preexisting IPP.

Molecular detection of the COVID-19 genome in prostatic tissue of patients with previous infection.

COVID-19 infection has been linked to worsening or de novo lower urinary tract symptoms and transient serum prostate-specific antigen rise in patients with benign prostatic hyperplasia. This pilot study aimed to examine prostatic tissue for evidence for direct involvement with the COVID-19 (SARS-CoV-2) infection. Fourteen patients with previous documented COVID-19 infection who underwent prostate enucleation had their prostate specimens examined for COVID-19 RNA. The specimens were examined using a SARS-CoV-2 test, an in vitro diagnostic test based on reverse transcription polymerase chain reaction technology that analyses the presence of RNA for the SARS-CoV-2 strain. Among the 14 patients, COVID infection was severe in three, mild in seven, and asymptomatic in four patients. The COVID-19 genome was successfully identified in the prostate specimen of a single patient. Although this patient had mild COVID-19 infection, he had positive COVID tests for 40 days after the initial infection. Identification of the COVID-19 genome in prostate tissue is a further step toward better understanding its effect on the genitourinary tract. This study's findings provide some explanation for the proposed association with lower urinary tract symptoms and rise in serum prostate-specific antigen levels. Larger studies are needed to further investigate this association.

Tandem Resonance metallic double-J ureteral stents in a single ureter for salvage management of chronic ureteral obstruction.

For chronic malignant and benign ureteral obstruction, the metal construction of the Resonance ureteral stent has been developed to maintain ureteral patency for up to 12 months, obviating the need for the frequent exchange required for conventional plastic ureteral stents. We report our experience placing tandem Resonance stents (TRS) in a single ureter of patients who failed management with a single Resonance stent. A retrospective review of patients who had TRS for management of ureteral obstruction between February 2014 and May 2017 was performed. Seven renal units from four patients with a median age of 62 years were managed with TRS. All but one renal unit was successfully managed with TRS initially. Hydronephrosis resolved in 80% of renal units at a median of 33 days, and creatinine reached its nadir a median of 38 days after placement, with a median improvement of 0.68 ng/mL. However, the median length of management with TRS was only 123.5 days with one exchange, and there was an overall success rate of 28.5% at 1 year. TRS placement is a feasible option for short-term management in a challenging population that would like to avoid nephrostomy and has failed other modalities.