Prevalence and prediction of urinary incontinence after transurethral surgery for prostatic hyperplasia: evaluation of different approaches

Introduction. Transurethral resection of the prostate (TURP) has historically been regarded as the gold standard surgical treatment for benign prostatic hyperplasia (BPH), although over the past two decades the spectrum of transurethral procedures has expanded substantially with the introduction of various enucleation techniques. Despite the favourable safety profile of contemporary technologies, urinary incontinence (UI) remains one of the most clinically significant complications following transurethral surgery for BPH.

Objective. To summarise current data on the incidence and classification of different forms of UI after transurethral procedures for BPH; to analyse key risk factors, and to critically appraise existing predictive models and nomograms, with a view to outlining prospects for their further refinement and clinical implementation.

Materials & methods. A literature search was performed in the PubMed and Elibrary.ru databases for the period from 1999 to 2026, restricted to publications in Russian and English.

Results. A central challenge in studying postoperative UI is the absence of a single standardised definition, with clinical studies employing both subjective measures (patient‑reported symptoms and validated questionnaires such as ICIQ‑SF, IPSS, UCLA‑PCI) and objective metrics (pad counts and 24‑hour pad tests). The principal mechanism of stress UI is injury to the external urethral sphincter at the prostatic apex and verumontanum due to mechanical trauma during enucleation and urethral dilation, whereas urgency UI is attributed to pre‑existing detrusor overactivity from chronic obstruction and to postoperative inflammation and bladder irritation, including potential thermal effects. Proposed risk factors for UI include age, body mass index, operative technique, prostate volume and growth pattern, urethral anatomy, urodynamic parameters, and surgeon experience. Based on these predictors, several prognostic models and nomograms have been developed in recent years to enable individualised assessment of postoperative UI risk and to improve preoperative counselling and surgical decision‑making.

Conclusion. Reported UI rates vary widely due to heterogeneity in definitions and assessment methods, highlighting the need for user‑friendly tools that facilitate implementation of predictive models in routine practice.

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