Research progress on stress urinary incontinence after benign prostatic hyperplasia surgery

doi:10.3877/cma.j.issn.1674-3253.2025.01.018

Abstract

Abstract:

Nowadays， Surgery remains the most effective way in treating benign prostate hyperplasia. However，any surgical method can cause urinary incontinence of different degrees and proportions. Postoperative scarring， combined with the compression of sphincter， destroyed the mechanism of urethral mucosa closure， causing postoperative stress urinary incontinence（SUI）. Voiding diary， pad test and cough stress test are the main methods in diagnosing urinary incontinence's type and degree. Pelvic floor muscle training， electrical stimulation treatment， medication on the other hands can alleviate urinary incontinence. For patients in whom conservative treatment is ineffective， urinary incontinence may be treated by injection of urethral bulking agents， male sling surgery and implantation of external compression device. Stem cell therapy SUI is showing promises but needs further validation.

Key words: Benign prostatic hyperplasia, Urinary incontinence, Transurethral enucleation of the prostate, Urodynamics, Pelvic floor muscle training, Electrical stimulation, Sling surgery, Artificial sphincter, Stem cell therapy, Aging

Hao Su, Mingyu Cao, Yiwei Guo, Xiaopeng Liu. Research progress on stress urinary incontinence after benign prostatic hyperplasia surgery[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 103-110.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2025.01.018

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2025/V19/I01/103

References 65

［1］	Gratzke C， Bachmann A， Descazeaud A， et al. EAU Guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction［J］. Eur Urol， 2015， 67（6）：1099-1109.
［2］	张卫东，王文佳，宋志强，等. 前列腺铥激光剜除术与等离子电切术治疗良性前列腺增生的对比研究［J］. 中华男科学杂志， 2024，30（6）： 514-518.Zhang WD， Wang WJ， Song ZQ， et al. Thulium laser enucleation versus plasma kinetic resection of the prostate in the treatment of benign prostatic hyperplasia ［J］. Natl J Androl， 2024， 30（6）： 514-518.
［3］	Serretta V， Morgia G， Fondacaro L， et al. Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s： a contemporary series of 1800 interventions［J］. Urology， 2002， 60（4）：623-627.
［4］	Ouanes Y， Hermi A， Chaker K， et al. Impact of urinary incontinence on the quality of life after open retropubic radical prostatectomy［J］.Cureus， 2022， 14（8）： e28106.
［5］	Nnabugwu II， Ugwumba FO， Udeh EI， et al. Learning transurethral resection of the prostate： a comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy［J］. Niger J Clin Pract， 2017， 20（12）： 1590-1595.
［6］	Das AK， Teplitsky S， Chandrasekar T， et al. Stress urinary incontinence post-holmium laser enucleation of the prostate： a singlesurgeon experience［J］. Int Braz J Urol， 2020， 46（4）： 624-631.
［7］	Lin CH， Wu WJ， Li CC， et al. Comparison of different en bloc holmium laser enucleation of the prostate techniques to reduce the rate of postoperative transient urinary incontinence［J］. J Int Med Res，2021， 49（8）： 3000605211037488.
［8］	车新艳，于书慧，王为，等. 经尿道前列腺电切术和铥激光剜除术治疗良性前列腺增生的早期尿控分析［J］. 微创泌尿外科杂志，2022， 11（3）： 194-198.Che XY， Yu SH， Wang W， et al. Early urinary control of thulium laser enucleation and transurethral resection for benign prostatic hyperplasia［J］. J Minim Invasive Urol， 2022， 11（3）： 194-198.
［9］	Cornu JN， Ahyai S， Bachmann A， et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction： an update［J］. Eur Urol， 2015，67（6）： 1066-1096.
［10］	李飞，耿杰，陈洪波，等. 经尿道前列腺等离子双极电切术治疗高危良性前列腺增生患者的多中心、前瞻性研究［J］. 医学新知，2024， 34（4）： 381-390.Li F， Geng J， Chen HB， et al. Transurethral plasmakinetic resection of prostate in high-risk benign prostatic hyperplasia patients： a multicenter prospective study ［J］. New Med， 2024， 34（4）： 381-390.
［11］	Koch GE， Kaufman MR. Male stress urinary incontinence［J］. Urol Clin North Am， 2022， 49（3）： 403-418.
［12］	蔡家乐，闻立平，何敏. 良性前列腺增生行经尿道前列腺切除术后尿道狭窄发生状况及外科治疗研究进展［J］. 新医学， 2024，55（8）： 663-670.Cai JL， Wen LP， He M. Research progress on the occurrence and surgical treatment of urethral stricture after transurethral resection of prostate for benign prostatic hyperplasia ［J］. J New Med， 2024，55（8）： 663-670.
［13］	Nam JK， Kim HW， Lee DH， et al. Risk factors for transient urinary incontinence after holmium laser enucleation of the prostate［J］.World J Mens Health， 2015， 33（2）： 88-94.
［14］	刘镇，于世翠，栾杰，等. 钬激光前列腺剜除术与等离子电切术治疗良性前列腺增生的疗效及安全性比较［J］. 中国中西医结合外科杂志， 2024， 30（3）： 372-376.Liu Z， Yu SC， Luan J， et al. Comparison of efficacy and safety of holmium laser enucleation of prostate and plasmakinetic resection of prostate in treating benign prostatic hyperplasia ［J］. Chin J Surg Integr Tradit West Med， 2024， 30（3）： 372-376.
［15］	Cho KJ， Koh JS， Choi JB， et al. Factors associated with early recovery of stress urinary incontinence following holmium laser enucleation of the prostate in patients with benign prostatic enlargement［J］. Int Neurourol J， 2018， 22（3）： 200-205.
［16］	Hirasawa Y， Kato Y， Fujita K. Age and prostate volume are risk factors for transient urinary incontinence after transurethral enucleation with bipolar for benign prostatic hyperplasia［J］. Int J Urol， 2018， 25（1）： 76-80.
［17］	Wittig L， Carlson KV， Andrews JM， et al. Diabetic bladder dysfunction： a review［J］. Urology， 2019， 123： 1-6.
［18］	Arai Y， Kaiho Y， Takei M， et al. Burden of male stress urinary incontinence： a survey among urologists in Japan［J］. Int J Urol， 2009，16（11）： 915-917.
［19］	van Kerrebroeck P， Abrams P， Chaikin D， et al. The standardisation of terminology in nocturia： report from the Standardisation Subcommittee of the International Continence Society［J］. Neurourol Urodyn， 2002， 21（2）： 179-183.
［20］	Abrams P， Cardozo L， Fall M， et al. The standardisation of terminology of lower urinary tract function： report from the Standardisation Sub-committee of the International Continence Society［J］. Am J Obstet Gynecol， 2002， 187（1）： 116-126.
［21］	Shelton TM， Brimley S， Tsambarlis P， et al. Current perspectives on complications of surgical treatments for male stress urinary incontinence［J］. Sex Med Rev， 2020， 8（3）： 443-449.
［22］	Ottaiano N， Shelton T， Sanekommu G， et al. Surgical complications in the management of benign prostatic hyperplasia treatment［J］. Curr Urol Rep， 2022， 23（5）： 83-92.
［23］	Nambiar AK， Bosch R， Cruz F， et al. EAU Guidelines on assessment and nonsurgical management of urinary incontinence［J］. Eur Urol，2018， 73（4）： 596-609.
［24］	张银，陈慧，张小青，等. 基于Web of Science数据库的前列腺癌根治术后尿失禁相关研究的可视化分析［J］. 实用临床医药杂志，2024， 28（10）： 17-23.Zhang Y， Chen H， Zhang XQ， et al. Visual analysis of urinary incontinence after radical prostatectomy based on Web of Science database ［J］. J Clin Med Pract， 2024， 28（10）： 17-23.
［25］	Hu JS， Pierre EF. Urinary incontinence in women： evaluation and management［J］. Am Fam Physician， 2019， 100（6）： 339-348.
［26］	Gaspar A， Koron N， Silva J， et al. Vaginal erbium laser for treatment of stress urinary incontinence： optimization of treatment regimen for a sustained long-term effect［J］. Lasers Med Sci， 2022， 37（4）： 2157-2164.
［27］	Soto González M， Da Cuña Carrera I， Lantarón Caeiro EM， et al. Correlation between the 1-hour and 24-hour pad test in the assessment of male patients with post-prostatectomy urinary incontinence［J］. Prog Urol， 2018， 28（11）： 536-541.
［28］	Medeiros Araujo C， de Morais NR， Sacomori C， et al. Pad test for urinary incontinence diagnosis in adults： systematic review of diagnostic test accuracy［J］. Neurourol Urodyn， 2022， 41（3）：696-709.
［29］	Guralnick ML， Fritel X， Tarcan T， et al. ICS Educational Module：cough stress test in the evaluation of female urinary incontinence：introducing the ICS-Uniform Cough Stress Test［J］. Neurourol Urodyn， 2018， 37（5）： 1849-1855.
［30］	Wen L， Zhao B， Chen W， et al. Real-time assessment of the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test （CST） in supine and standing positions using transperineal ultrasound［J］. Int Urogynecol J， 2020， 31（12）： 2515-2519.
［31］	Osman NI， Marzi VL， Cornu JN， et al. Evaluation and classification of stress urinary incontinence： current concepts and future directions［J］. Eur Urol Focus， 2016， 2（3）： 238-244.
［32］	Henderson JW， Kane SM， Mangel JM， et al. A randomized comparative study evaluating various cough stress tests and 24-hour pad test with urodynamics in the diagnosis of stress urinary incontinence［J］. J Urol， 2018， 199（6）： 1557-1564.
［33］	张帆，廖利民. 前列腺术后尿失禁尿动力检查特点及其临床价值［J］. 现代泌尿外科杂志， 2022， 27（9）： 768-773.Zhang Fan，Liao Limin.Characteristies and clinical value of urodynamie study on post prostatectomy incontinence： a report of 36 cases ［J］. J Mod Urol， 2022， 27（9）： 768-773.
［34］	D'Alessandro G， Palmieri S， Cola A， et al. Correlation between urinary symptoms and urodynamic findings： is the bladder an unreliable witness？［J］. Eur J Obstet Gynecol Reprod Biol， 2022， 272：130-133.
［35］	Gacci M， Sebastianelli A， Salvi M， et al. The impact of central obesity on storage luts and urinary incontinence after prostatic surgery［J］. Curr Urol Rep， 2016， 17（9）： 61.
［36］	Bradley CS， Erickson BA， Messersmith EE， et al. Evidence of the impact of diet， fluid intake， caffeine， alcohol and tobacco on lower urinary tract symptoms： a systematic review［J］. J Urol， 2017， 198（5）：1010-1020.
［37］	Gacci M， Sakalis VI， Karavitakis M， et al. European association of urology guidelines on male urinary incontinence［J］. Eur Urol， 2022，82（4）： 387-398.
［38］	Sciarra A， Viscuso P， Arditi A， et al. A biofeedback-guided programme or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy：a meta-analysis and systematic review［J］. Int J Clin Pract， 2021，75（10）： e14208.
［39］	Filocamo MT， Marzi VL， Del Popolo G， et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence［J］. Eur Urol， 2005， 48（5）： 734-738.
［40］	Sandhu JS. Treatment options for male stress urinary incontinence［J］.Nat Rev Urol， 2010， 7（4）： 222-228.
［41］	Sandhu JS， Breyer B， Comiter C， et al. Incontinence after prostate treatment： AUA/SUFU Guideline［J］. J Urol， 2019， 202（2）： 369-378.
［42］	Kannan P， Winser SJ， Fung B， et al. Effectiveness of pelvic floor muscle training alone and in combination with biofeedback， electrical stimulation， or both compared to control for urinary incontinence in men following prostatectomy： systematic review and metaanalysis［J］. Phys Ther， 2018， 98（11）： 932-945.
［43］	Soto González M， Da Cuña Carrera I， Gutiérrez Nieto M， et al. Early 3-month treatment with comprehensive physical therapy program restores continence in urinary incontinence patients after radical prostatectomy： a randomized controlled trial［J］. Neurourol Urodyn，2020， 39（5）： 1529-1537.
［44］	Stewart F， Gameiro LF， El Dib R， et al. Electrical stimulation with non-implanted electrodes for overactive bladder in adults［J］.Cochrane Database Syst Rev， 2016， 12（12）： CD010098.
［45］	Kotecha P， Sahai， Malde S. Use of duloxetine for postprostatectomy stress urinary incontinence： a systematic review［J］. Eur Urol Focus，2021， 7（3）： 618-628.
［46］	Boy S， Reitz A， Wirth B， et al. Facilitatory neuromodulative effect of duloxetine on pudendal motor neurons controlling the urethral pressure： a functional urodynamic study in healthy women［J］. Eur Urol， 2006， 50（1）： 119-125.
［47］	Averbeck MA， Woodhouse C， Comiter C， et al. Surgical treatment of post-prostatectomy stress urinary incontinence in adult men： report from the 6th International Consultation on Incontinence［J］. Neurourol Urodyn， 2019， 38（1）： 398-406.
［48］	Serati M， Mancini V， Balzarro M. Urethral bulking agents for the treatment of female stress urinary incontinence［J］. Int Urogynecol J，2020， 31（8）： 1493-1494.
［49］	Kowalik CG， DeLong JM， Mourtzinos AP. The advance transobturator male sling for post-prostatectomy incontinence：subjective and objective outcomes with 3 years follow up［J］.Neurourol Urodyn， 2015， 34（3）： 251-254.
［50］	Collado A， Domínguez-Escrig J， Ortiz Rodríguez IM， et al.Functional follow-up after Advance^® and Advance XP^® male sling surgery： assessment of predictive factors［J］. World J Urol， 2019，37（1）： 195-200.
［51］	Bauer RM， Grabbert MT， Klehr B， et al. 36-month data for the AdVance XP^® male sling： results of a prospective multicentre study［J］. BJU Int， 2017， 119（4）： 626-630.
［52］	Galiano M， Guillot-Tantay C， Sivaraman A， et al. Superficial implantation of the I-stop TOMS transobturator sling in the treatment of postprostatectomy urinary incontinence： description of a novel technique and 1-year outcomes［J］. Urology， 2016， 90： 195-198.
［53］	Angulo JC， Ruiz S， Lozano M， et al. Systematic review and metaanalysis comparing Adjustable Transobturator Male System （ATOMS）and male Readjustment Mechanical External （REMEEX） system for post-prostatectomy incontinence［J］. World J Urol， 2021， 39（4）： 1083-1092.
［54］	Márquez-Sánchez GA， Padilla-Fernández BY， Perán-Teruel M， et al.Remeex^® system effectiveness in male patients with stress urinary incontinence［J］. J Clin Med， 2021， 10（10）： 2121.
［55］	Bochove-Overgaauw DM， Schrier BP. An adjustable sling for the treatment of all degrees of male stress urinary incontinence：retrospective evaluation of efficacy and complications after a minimal followup of 14 months［J］. J Urol， 2011， 185（4）： 1363-1368.
［56］	Bajaj M， Frampton C， Losco G， et al. Adjustable transobturator male system （ATOMS） for stress urinary incontinence： the evidence is mounting［J］. BJU Int， 2024， 133（Suppl 3）： 33-38.
［57］	朱晖，邓康俐. 前列腺癌根治术后尿失禁的治疗现状和展望［J］.肿瘤防治研究， 2020， 47（10）： 727-733.Zhu H， Deng KL. Current status and future directions of treatment of post-prostatectomy urinary incontinence in prostate cancer［J］. Cancer Res Prev Treat， 2020， 47（10）： 727-733.
［58］	Larson T， Jhaveri H， Yeung LL. Adjustable continence therapy（ProACT） for the treatment of male stress urinary incontinence： a systematic review and meta-analysis［J］. Neurourol Urodyn， 2019，38（8）： 2051-2059.
［59］	Gallo F， Ninotta G， Schenone M， et al. Advances in stem cell therapy for male stress urinary incontinence［J］. Expert Opin Biol Ther， 2019，19（4）： 293-300.
［60］	Eberli D， Aboushwareb T， Soker S， et al. Muscle precursor cells for the restoration of irreversibly damaged sphincter function［J］. Cell Transplant， 2012， 21（9）： 2089-2098.
［61］	Schmid FA， Williams JK， Kessler TM， et al. Treatment of stress urinary incontinence with muscle stem cells and stem cell components： chances， challenges and future prospects［J］. Int J Mol Sci， 2021， 22（8）： 3981.
［62］	Mitterberger M， Marksteiner R， Margreiter E， et al. Autologous myoblasts and fibroblasts for female stress incontinence： a 1-year follow-up in 123 patients［J］. BJU Int， 2007， 100（5）： 1081-1085.
［63］	Mitterberger M， Marksteiner R， Margreiter E， et al. Myoblast and fibroblast therapy for post-prostatectomy urinary incontinence： 1-year followup of 63 patients［J］. J Urol， 2008， 179（1）： 226-231.
［64］	Gotoh M， Yamamoto T， Kato M， et al. Regenerative treatment of male stress urinary incontinence by periurethral injection of autologous adipose-derived regenerative cells： 1-year outcomes in 11 patients［J］. Int J Urol， 2014， 21（3）： 294-300.
［65］	Musavi L， Brandacher G， Hoke A， et al. Muscle-derived stem cells：important players in peripheral nerve repair［J］. Expert Opin Ther Targets， 2018， 22（12）： 1009-1016.

[1]	Guangjuan Kan, Liqun un, Minyan Wang, Yanyu Li, Yanjuan Tan, Yuxuan Qiu, Shushu Pan, Jiang Zhu. Multimodal imaging manifestations of gastric-type endocervical adenocarcinoma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(11): 1030-1041.
[2]	Jianquan Zhang, Jie Cheng, Hongqiong Chen, Lei Yan. Evaluation of ablated thyroid areas using ACR-TIRADS：a survey study [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(10): 966-971.
[3]	Xuebing Shi, Yingdong Xie, Ni Xie, Chaoli Xu, Bin Yang, Guo Sun. Acoustic radiation force imaging for evaluating efficacy of radiotherapy in unresectable hepatocellular carcinoma patients with portal vein tumor thrombus [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(08): 778-784.
[4]	Chang Liu, Jie Jiang, Xuedong Xu, Ligang Cui, Shumin Wang, Wen Chen. Survey of basic situation of thyroid ultrasonography and use of TIRADS classification in hospitals in Haidian District, Beijing [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 693-697.
[5]	Wenjia Cao, Xuebing Liu, Anguo Luo, Shimin Zhong, Lan Deng, Yulin Wang, Zhaohuan Li. Evaluation of wall shear stress of the carotid artery by ultrasound vector flow imaging in patients with type 2 diabetes mellitus [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 709-717.
[6]	Qianmei Li, Guannan He, Jing Zhao, Xi Chen, Yuying Tang, Liqiong Ma, Rong Liang, Tao Yuan, Mingxing Li. Placental microvascular flow imaging characteristics and prognosis of early low-risk and high-risk pregnancies [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 726-732.
[7]	Daiqin Li, Peijie Liu. Value of dynamic enhanced magnetic resonance imaging in evaluating the efficacy and prognosis of middle and advanced low rectal cancer after concurrent chemoradiotherapy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 100-103.
[8]	Xingqi Wang, Jihong Shen. Clinical application of single branch mesh total urethral suspension combined with biomechanical reconstruction of the posterior pelvic floor [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 1-6.
[9]	Jieying Chen, Jingying Xu, Zeping Huang. Progress in the application of ultrasound in the diagnosis and efficacy evaluation of female stress urinary incontinence [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 14-20.
[10]	Tianlong Luo, Qingqing He, Hai Huang. Long-term comprehensive management of chronic urinary dysfunction and the practice of sustainable rehabilitation [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 21-26.
[11]	Feipeng Song, Yingsheng Wang, Hongbo Xu, Fajin Lv. Impact of different previous cancer history on the diagnostic efficiency of PNI-GARS and Lung-RADS [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(06): 925-930.
[12]	Ziyang Peng, Zhibo Wang, He Ba, Yan Yan, Haoqian Peng, Yu Li, Xuemin Liu, Junxi Xiang, Rongqian Wu, Yi Lyu. Application of augmented reality, virtual reality and mixed reality in laparoscopic liver surgery [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(01): 13-17.
[13]	Zhejing Wu, Jingdong Li, Yongfu Xiong, Gang Liu, Lei Chen. Application of indocyanine green in anatomical hepatectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(01): 25-29.
[14]	Zongming Zhang, Jiahong Dong, Xiaodong He, Qiusheng Wang, Zhi Xu, Limin Liu, Chong Zhang. Controversy and reflection on hot issues of biliary surgery in elderly patients [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 754-762.
[15]	Jingming Wang, Lei Wang, Xiaoduo Xu, Wenqiang Xing, Zhaoyan Zhang, Weimin Huang. Advances in research of paravertebral muscles of the lumbar spine [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(09): 846-852.

Please choose a citation manager

Content to export