Does the use of a small-size resectoscope during enucleation prevent transient urinary leakage and urethral stricture following holmium laser enucleation of the prostate?

Objective: To investigate the effect of the use of a small-size resectoscope for enucleation during holmium laser enucleation of the prostate (HoLEP) on the prevention of transient urinary leakage (TUL) and urethral stricture (US).

Methods: One hundred patients were included in a retrospective single-center study from January 2019 to December 2020. The patients were divided into two groups according to the resectoscope size which was used for enucleation (22F in group A [n = 40] and 26F in group B [n = 60]). Patients were evaluated at 4, 12, and 24 weeks postoperatively for TUL and US. Univariate and multivariate regression analyses were implemented to assess the variables which are associated with TUL at 4 weeks.

Results: Baseline characteristics and perioperative data were observed to be well balanced between groups. A statistically significant higher occurrence of TUL was detected at 4 weeks in group B compared to group A (P = .018). Higher improvement in International Prostate Symptom Score (IPSS) and quality of life (QoL) was observed in group A at 4 and 12 weeks postoperatively. On univariate analysis, resectoscope size, specimen weight, and body mass index were significant predictive factors for TUL at 4 weeks. Multivariate analysis illustrated that the resectoscope size was independently associated with TUL at 4 weeks after HoLEP (odds ratio = 3.1 [1.02-9.38]). One patient in group A (2.5%) and two patients in group B (5%) demonstrated US (P = .648).

Conclusion: Enucleation with a 22F resectoscope provides better QoL and IPSS by reducing TUL rates in the early postoperative period.