Distinct predictors of stress vs. urge urinary incontinence after transurethral prostatectomy: A prospective cohort study.

INTRODUCTION Urinary incontinence (UI) remains a distressing complication following surgical treatment of benign prostatic hyperplasia (BPH). Although postoperative UI is well described, few prospective studies have distinguished predictors of stress urinary incontinence (SUI) from those of urge urinary incontinence (UUI).

Methods

In this prospective cohort study (July 2022-July 2024), 133 men undergoing bipolar transurethral resection of the prostate (B-TURP) or bipolar enucleation of the prostate (BipolEP) were followed-up for ≥ 1 year. Preoperative and intraoperative variables were evaluated using univariate testing and multivariable logistic regression to identify independent predictors of persistent SUI and UUI.

Results

SUI occurred in 20.3% of patients and was independently associated with older age and use of the enucleation technique with additional univariate associations observed for larger prostate volume, lower baseline Qmax, and greater resected tissue weight. UUI occurred in 15.8% and was independently predicted by higher IPSS scores and preoperative detrusor overactivity with univariate association also noted for older age; no intraoperative factor predicted UUI.

Conclusions

SUI is primarily driven by anatomical and surgical factors, whereas UUI reflects underlying bladder dysfunction. Differentiating these predictive profiles supports individualized patient counseling, procedural planning, and preoperative risk stratification for men undergoing transurethral prostatectomy.