Early Urinary Incontinence after Sphincter-Preserving Bipolar Enucleation of the Prostate versus Bipolar Transurethral Resection of the Prostate
D. S. Suhas, Maneesh SinhaAbstract
Introduction:
Transient urinary incontinence remains one of the most concerning complications following endoscopic surgery for benign prostatic hyperplasia (BPH). Although bipolar enucleation of the prostate (BEP) provides superior adenoma clearance, concerns persist regarding sphincter-related injury and early postoperative incontinence. This study evaluated the impact of sphincter-preserving modifications during BEP on early urinary continence compared with bipolar transurethral resection of the prostate (TURP).
Materials and Methods:
A prospective study was conducted on patients undergoing surgery for BPH between July 2023 and January 2025. A total of 70 patients were included, with 35 patients in the BEP group and 35 patients in the TURP group. The enucleation technique incorporated modifications aimed at sphincter preservation, including early apical separation, minimal traction at the apex, and preservation of bladder neck. Urinary incontinence was assessed using the International Continence Society pad test on postoperative day 2, at 2 weeks, and at 3 months.
Results:
The BEP group had significantly larger prostates (63.0 ± 26.9 g vs. 45.9 ± 29.8 g;
Conclusions:
Although the severity of early urinary incontinence was higher following BEP, most cases were mild, transient, and resolved during the follow-up. Sphincter-preserving modifications may reduce the severity of postoperative incontinence and facilitate acceptable continence outcomes comparable to TURP by 3 months.