Predictors of de novo urge urinary incontinence after photoselective vaporization of the prostate

To investigate serial changes in the incidences of de novo urge urinary incontinence (UUI) after photoselective vaporization of the prostate (PVP) for BPH using a validated questionnaire, OABSS, and to determine predictors of postoperative de novo UUI (dnUUI).

A total of 84 men, for whom 12-month follow-up data were available and who did not complain of UUI based on the OABSS [score of OABSS question 4 (OABSS4) ≤1], were included in this study. Outcomes were evaluated at 1 week, and 1, 3, 6, and 12 months postoperatively using IPSS, OABSS, and uroflowmetry. The presence of de novo UUI was defined as OABSS4 ≥2 at the follow-up visit.

Maximum flow rate (Qmax), post-void residual urine volume, voiding symptom score, total IPSS, and QOL index improved from 1 week. Storage symptom score and total OABSS improved from 3 months. Incidences of postoperative dnUUI at 1 week, and 1, 3, and 6 months were 42.9, 27.4, 14.3, and 0.0 %, respectively. The decrease in QOL index in patients with dnUUI at each follow-up visit was lesser than in those without dnUUI. On multivariate regression analysis, older age, shorter time to Qmax on baseline uroflowmetry, higher storage symptom score, higher total OABSS, smaller bladder volume at first desire to void, and smaller maximum cystometric capacity (MCC) on baseline urodynamics were independent predictors of occurrence of dnUUI.

Our data indicate that transient dnUUI occurs in a significant proportion of patients after PVP and it tends to decrease over time. Older-aged patients, patients with shorter time to Qmax, higher baseline storage symptom score, higher baseline total OABSS, smaller bladder volume at first desire to void, and smaller MCC may be prone to develop dnUUI postoperatively.