urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2026-14-4-5-13urovest-1254Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЧастота и факторы риска стрессового недержания мочи после тулиевой волоконной энуклеации гиперплазии простатыStress urinary incontinence following thulium fiber laser enucleation of the prostate: incidence and risk factors analysishttps://orcid.org/0000-0003-4251-7545КамаловА. А.KamalovA. A.

Армаис Альбертович Камалов — д-р мед. наук, профессор, академик РАН 

Москва

Armais A. Kamalov — Dr.Sc.(Med), Full Prof., Acad. of the RAS

Moscow 

armais.kamalov@rambler.ruhttps://orcid.org/0000-0001-9466-7567СорокинН. И.SorokinN. I.

Николай Иванович Сорокин — д-р мед. наук 

Моква

Nikolay I. Sorokin — Dr.Sc.(Med) 

Moscow 

nisorokin@mail.ruhttps://orcid.org/0000-0003-4518-634XСтригуновА. А.StrigunovA. A.

Андрей Алексеевич Стригунов — канд. мед. наук 

Москва

Andrey A. Strigunov — Cand.Sc.(Med)  

Moscow 

an-strigunov@yandex.ruhttps://orcid.org/0000-0003-3355-4547НестероваО. Ю.NesterovaO. Yu.

Ольга Юрьевна Нестерова — канд. мед. наук 

Москва

Olga Yu. Nesterova — Cand.Sc.(Med) 

Moscow 

oy.nesterova@gmail.comhttps://orcid.org/0009-0004-0780-6995МещеряковаЕ. А.MeshcheriakovaE. A.

Елена А. Мещерякова 

Москва

Elena A. Meshcheriakova 

Moscow 

elenastrepetova03@gmail.comhttps://orcid.org/0009-0000-9115-7799БурлаковИ. Д.BurlakovI. D.

Илья Д. Бурлаков 

Москва

Ilya D. Burlakov 

Moscow 

forffmmsu@gmail.comМосковский государственный университет им. М.В. ЛомоносоваРоссияLomonosov Moscow State UniversityRussian Federation202622082026144513Copyright © Камалов А.А., Сорокин Н.И., Стригунов А.А., Нестерова О.Ю., Мещерякова Е.А., Бурлаков И.Д., 20262026Камалов А.А., Сорокин Н.И., Стригунов А.А., Нестерова О.Ю., Мещерякова Е.А., Бурлаков И.Д.Kamalov A.A., Sorokin N.I., Strigunov A.A., Nesterova O.Y., Meshcheriakova E.A., Burlakov I.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/1254

Введение. Тулиевая волоконная энуклеация гиперплазии простаты (ThuFLEP) является эффективным малоинвазивным методом хирургического лечения гиперплазии простаты, позволяющим выполнять полное анатомическое удаление аденоматозной ткани с хорошим гемостазом и возможностью применения при всех объёмах предстательной железы. Несмотря на высокую эффективность эндоскопических методов энуклеации, раннее послеоперационное стрессовое недержание мочи остаётся одним из наиболее клинически значимых функциональных осложнений, влияющих на качество жизни пациентов и их удовлетворённость результатами операции.Цель исследования. Оценить частоту и факторы риска стрессового недержания мочи после ThuFLEP, выполненной одним урологом с опытом более 3000 эндоскопических энуклеаций.Материалы и методы. С мая 2021 года по сентябрь 2022 года ThuFLEP была выполнена 381 пациенту. В качестве источника лазерной энергии использовали аппарат Fiberlase U3 (IRE Polus Ltd, Фрязино, Россия) со стандартными настройками: 1,5 Дж, 40 Гц, 60 Вт.Результаты. Стрессовое недержание мочи после ThuFLEP было выявлено у 45 пациентов (11,8%). Только у 1 пациента (0,3% от общей выборки) симптомы сохранялись более 3 месяцев, тогда как у остальных пациентов недержание регрессировало в течение 3 месяцев после операции. Исследование профиля уретрального давления у пациента с персистирующим стрессовым недержанием мочи выявило выраженную сфинктерную недостаточность, которая была успешно скорректирована на фоне комплексной реабилитации. По данным однофакторного регрессионного анализа было показано, что балл IPSS является фактором риска стрессового недержания: при увеличении показателя на каждый 1 балл вероятность недержания возрастала в 1,074 раза (95% ДИ 1,007 – 1,145; p = 0,029). Защитным фактором являлось использование техники en-bloc: вероятность стрессового недержания снижалась на 89,4% (95% ДИ 0,014 – 0,789; p = 0,028). Многофакторный регрессионный анализ показал аналогичную тенденцию, однако различия не достигли статистической значимости.Заключение. Стрессовое недержание мочи после ThuFLEP выявляется у 11,8% пациентов и в 99,7% случаев регрессирует в течение 3 месяцев после операции. Фактором риска стрессового недержания мочи является выраженность симптомов по шкале IPSS, тогда как выполнение ThuFLEP в технике en-bloc выступает защитным фактором.

Introduction. Thulium fiber laser enucleation of the prostate (ThuFLEP) is an effective, minimally invasive surgical option for benign prostatic obstruction, enabling complete anatomical adenoma removal with excellent hemostasis and applicability across a wide range of prostate volumes. Despite the high efficacy of endoscopic enucleation techniques, early postoperative stress urinary incontinence (SUI) remains one of the most clinically relevant functional complications, adversely affecting patients’ quality of life and satisfaction with surgery.Objective. To determine the incidence and potential risk factors for SUI following ThuFLEP performed by a single surgeon with experience of more than 3000 endoscopic enucleations.Materials & methods. Between May 2021 and September 2022, ThuFLEP was performed in 381 patients. The FiberLase U3 system (IRE Polus Ltd., Fryazino, Russia) was used as the laser source, with standard settings of 1.5 J, 40 Hz, 60 W.Results. SUI occurred in 45 patients (11.8%) after ThuFLEP. Only one patient (0.3% of the cohort) had symptoms persisting beyond 3 months, whereas SUI resolved within 3 months in the remaining 99.7% of cases. Urethral pressure profilometry in the single patient with persistent SUI demonstrated marked sphincter insufficiency, which was successfully managed with comprehensive rehabilitation. On univariate regression analysis, preoperative IPSS was identified as a risk factor for SUI: each one-point increase in IPSS was associated with a 1.074-fold rise in the odds of SUI (95% CI 1.007–1.145, p = 0.029). Use of the en-bloc technique emerged as a protective factor, reducing the odds of SUI by 89.4% (95% CI 0.014–0.789, p = 0.028). Multivariate regression analysis showed a similar trend, although the differences did not reach statistical significance, in line with prior ThuFLEP series.Conclusion. SUI after ThuFLEP is observed in 11.8% of patients and resolves within 3 months in 99.7% of cases. Greater baseline symptom severity as measured by IPSS increases the risk of postoperative SUI, whereas en-bloc ThuFLEP appears to confer a protective effect.

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The authors declare that there are no conflicts of interest present.