Rehabilitation options for patients with different types of urinary incontinence following transurethral surgery for benign prostatic hyperplasia

Introduction. Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for benign prostatic hyperplasia (BPH), while various endoscopic enucleation techniques are gaining increasing popularity. Despite the advantages of the minimally invasive transurethral approach, urinary incontinence (UI) remains one of the most significant and undesirable postoperative complications, potentially developing in the postoperative period and substantially impairing daily activities.

Objective. To evaluate treatment options for UI following transurethral surgery for BPH.

Materials & methods. A systematic review of the PubMed and Elibrary.ru databases was conducted for the period from 1999 to 2026 to identify all relevant studies. The search was limited to publications in Russian and English.

Results. Following transurethral surgery for BPH, various UI types may develop, including urge, stress, and mixed incontinence. Reported rates of UI after transurethral procedures for BPH vary considerably across the literature, ranging from 0.5% to 60%. This wide variability reflects the lack of a unified definition and diagnostic approach to this  complication.  Management  of  urge  urinary  incontinence  after  transurethral  surgery  for  BPH  involves a multimodal approach, including anti-inflammatory and antibacterial agents, antimuscarinics, and beta-3 adrenergic receptor agonists; in more severe cases, intradetrusor botulinum toxin injections are employed. For stress urinary incontinence (SUI) associated with the transurethral approach in BPH, first-line therapy consists of pelvic floor muscle training (including biofeedback-guided exercises, magnetic or electrical stimulation). In more severe cases, surgical interventions are considered, such as sling placement or artificial urinary sphincter implantation.

Conclusion. Pelvic floor muscle training represents one of the most promising treatment modalities for UI following transurethral surgery for BPH. However, further research is needed to clarify optimal rehabilitation strategies, as current evidence remains insufficient to fully assess the efficacy, safety, and potential interactions of different treatment approaches for post-transurethral incontinence in men.

1. Vasanwala F.F., Wong M.Y.C., Ho H.S.S., Foo K.T. Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians. Asian Journal of Urology. 2017;4(3):181-184. DOI: 10.1016/j.ajur.2017.05.003

2. Egan K.B. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am. 2016;43(3):289-297. DOI: 10.1016/j.ucl.2016.04.001

3. Vos T., Flaxman A.D., Naghavi M., Lozano R., Michaud C., Ezzati M., Shibuya K., SalomonJ.A., Abdalla S., Aboyans V., Abraham J., Ackerman I., Aggarwal R., AhnS.Y., Ali M.K., Alvarado M., Anderson H.R., Anderson L.M., Andrews K.G., Atkinson C., Baddour L.M., Bahalim A.N., Barker-Collo S., Barrero L.H., Bartels D.H., Basáñez M.G., Baxter A., Bell M.L., Benjamin E.J., Bennett D., Bernabé E., Bhalla K., Bhandari B., Bikbov B., Bin Abdulhak A., Birbeck G., Black J.A., Blencowe H., Blore J.D., Blyth F., Bolliger I., Bonaventure A., Boufous S., Bourne R., Boussinesq M., Braithwaite T., Brayne C., Bridgett L., Brooker S., Brooks P., Brugha T.S., Bryan-Hancock C., Bucello C., Buchbinder R., Buckle G., Budke C.M., Burch M., Burney P., Burstein R., Calabria B., Campbell B., Canter C.E., Carabin H., Carapetis J., Carmona L., Cella C., Charlson F., Chen H., Cheng A.T., Chou D., Chugh S.S., Coffeng L.E., Colan S.D., Colquhoun S., Colson K.E., Condon J., Connor M.D., Cooper L.T., CorriereM., Cortinovis M., de Vaccaro K.C., CouserW., Cowie B.C., Criqui M.H., Cross M., Dabhadkar K.C., Dahiya M., Dahodwala N., Damsere-Derry J., Danaei G., Davis A., De Leo D., Degenhardt L., Dellavalle R., Delossantos A., Denenberg J., Derrett S., Des Jarlais D.C., Dharmaratne S.D., Dherani M., Diaz-Torne C., Dolk H., Dorsey E.R., Driscoll T., Duber H., Ebel B., Edmond K., Elbaz A., Ali S.E., Erskine H., Erwin P.J., Espindola P., Ewoigbokhan S.E., Farzadfar F., Feigin V., Felson D.T., Ferrari A., Ferri C.P., Fèvre E.M., Finucane M.M., Flaxman S., Flood L., Foreman K., Forouzanfar M.H., Fowkes F.G., Franklin R., Fransen M., Freeman M.K., Gabbe B.J., Gabriel S.E., Gakidou E., Ganatra H.A., Garcia B., Gaspari F., Gillum R.F., Gmel G., Gosselin R., Grainger R., Groeger J., Guillemin F., Gunnell D., Gupta R., Haagsma J., Hagan H., Halasa Y.A., Hall W., Haring D., Haro J.M., Harrison J.E., Havmoeller R., Hay R.J., Higashi H., Hill C., Hoen B., Hoffman H., Hotez P.J., Hoy D., Huang J.J., Ibeanusi S.E., Jacobsen K.H., James S.L., Jarvis D., Jasrasaria R., Jayaraman S., Johns N., Jonas J.B., Karthikeyan G., Kassebaum N., Kawakami N., Keren A., Khoo J.P., King C.H., Knowlton L.M., Kobusingye O., Koranteng A., Krishnamurthi R., Lalloo R., Laslett L.L., Lathlean T., LeasherJ.L., Lee Y.Y., Leigh J., Lim S.S., Limb E., Lin J.K., Lipnick M., Lipshultz S.E., Liu W., Loane M., Ohno S.L., Lyons R., Ma J., Mabweijano J., MacIntyre M.F., Malekzadeh R., Mallinger L., Manivannan S., Marcenes W., March L., Margolis D.J., Marks G.B., Marks R., Matsumori A., Matzopoulos R., Mayosi B.M., McAnulty J.H., McDermott M.M., McGill N., McGrath J., Medina-Mora M.E., Meltzer M., Mensah G.A., Merriman T.R., Meyer A.C., Miglioli V., Miller M., Miller T.R., Mitchell P.B., Mocumbi A.O., Moffitt T.E., Mokdad A.A., Monasta L., Montico M., Moradi-Lakeh M., Moran A., Morawska L., Mori R., Murdoch M.E., Mwaniki M.K., Naidoo K., Nair M.N., Naldi L., Narayan K.M., Nelson P.K., Nelson R.G., Nevitt M.C., Newton C.R., Nolte S., Norman P., Norman R., O’Donnell M., O’Hanlon S., Olives C., Omer S.B., Ortblad K., Osborne R., Ozgediz D., Page A., Pahari B., Pandian J.D., Rivero A.P., Patten S.B., Pearce N., Padilla R.P., Perez-Ruiz F., Perico N., Pesudovs K., Phillips D., Phillips M.R., Pierce K., Pion S., Polanczyk G.V., Polinder S., Pope CA 3rd, Popova S., Porrini E., Pourmalek F., Prince M., Pullan R.L., Ramaiah K.D., Ranganathan D., Razavi H., Regan M., Rehm J.T., Rein D.B., Remuzzi G., Richardson K., Rivara F.P., Roberts T., Robinson C., De Leòn F.R., Ronfani L., Room R., Rosenfeld L.C., Rushton L., Sacco R.L., Saha S., Sampson U., Sanchez-Riera L., Sanman E., Schwebel D.C., Scott J.G., Segui-Gomez M., Shahraz S., Shepard D.S., Shin H., Shivakoti R., Singh D., Singh G.M., Singh J.A., Singleton J., Sleet D.A., Sliwa K., Smith E., Smith J.L., Stapelberg N.J., Steer A., Steiner T., Stolk W.A., Stovner L.J., Sudfeld C., Syed S., Tamburlini G., Tavakkoli M., Taylor H.R., Taylor J.A., Taylor W.J., Thomas B., Thomson W.M., Thurston G.D., Tleyjeh I.M., Tonelli M., Towbin J.A., Truelsen T., Tsilimbaris M.K., Ubeda C., Undurraga E.A., van der Werf M.J., van Os J., Vavilala M.S., Venketasubramanian N., Wang M., Wang W., Watt K., Weatherall D.J., Weinstock M.A., Weintraub R., Weisskopf M.G., Weissman M.M., White R.A., Whiteford H., Wiersma S.T., Wilkinson J.D., Williams H.C., Williams S.R., Witt E., Wolfe F., Woolf A.D., Wulf S., Yeh P.H., Zaidi A.K., Zheng Z.J., Zonies D., Lopez A.D., Murray C.J., AlMazroa M.A., Memish Z.A. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-2196. DOI: 10.1016/S0140-6736(12)61729-2

4. Foé C.M.E., Liao Y., Zhang G. A Review on Urinary Incontinence after Surgery for Benign Prostatic Hyperplasia. OJU. 2022;12(03):169-184. DOI: 10.4236/oju.2021.123017

5. Aybal H.C., Yilmaz M., Barlas I.S., Duvarci M., Tuncel A., Tunc L. Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis. World J Urol. 2024;42(1):374. DOI: 10.1007/s00345-024-05082-2

6. Bucca B., Gozzi C., Gobbi L.M., Bologna E., Licari L.C., Asero V., Dalpiaz O., Alber T., Calarco A., Martini M., Presicce F. The dark side of transurethral access for LUTS/BPH surgery: a narrative review. Asian J Androl. 2026;28(1):46-56. DOI: 10.4103/aja202523

7. Volkov S.N., Pushkar D.Yu., Kolontarev K.B., Stepanchenko V.S., Tereshchenko V.I., Dzharimok A.R., Shevyakina A.E., Daurov M.A. The severity of lower urinary tract symptoms during the postoperative period as a factor in choosing an approach to surgical treatment for large prostate hyperplasia: holmium enucleation of the prostate (HoLEP) vs laparoscopic simple prostatectomy. Urology Herald. 2024;12(2):5-14. (In Russian). DOI: 10.21886/2308-6424-2024-12-2-5-14

8. Martov A.G., Merinov D.S., Kornienko S.I., Gushchin B.L., Ergakov D.V., Mustafaev E.M., Borisenko EA. [Postoperative urological complications of transurethral electrosurgical interventions on the prostate for adenoma]. Urologiia. 2006;(2):25-32. (In Russian). PMID: 16708585

9. Kruglov V.A., Asfandiyarov F.R., Seidov K.S., Oflidi K.G., Aliev R.T., Murzagalieva A.N., Hiji M.F., Valitova E.Kh. Conservative treatment of urinary incontinence after transurethral resection of the prostate. Experimental and Clinical Urology. 2023;16(1):90-98. (In Russian). DOI: 10.29188/2222-8543-2023-16-1-90-98

10. Yang M., Huang Y., Gao F., He L., Yu X., Yu Q. Meta-analysis of postoperative urinary incontinence incidence and risk factors in HoLEP. Ther Adv Urol. 2024;16:17562872241281578. DOI: 10.1177/17562872241281578

11. Castellani D., Rubilotta E., Fabiani A., Maggi M., Wroclawski M.L., Teoh J.Y., Pirola G.M., Gubbiotti M., Pavia M.P., Gomez-Sancha F., Galosi A.B., Gauhar V. Correlation Between Transurethral Interventions and Their Influence on Type and Duration of Postoperative Urinary Incontinence: Results from a Systematic Review and Meta-Analysis of Comparative Studies. J Endourol. 2022;36(10):1331-1347. DOI: 10.1089/end.2022.0222

12. He M., Mao C., Shu Y., Liu X. Urinary Incontinence Following Transurethral Prostatectomy: Current Status and Nursing Strategies. Biol Res Nurs. 2025;27(3):423-429. DOI: 10.1177/10998004251318909

13. Blackburn S.C., Jones C., Bedoya S., Steinbrecher H.A., Malone P.S., Griffin S.J. Intravesical botulinum type-A toxin (Dysport®) in the treatment of idiopathic detrusor overactivity in children. J Pediatr Urol. 2013;9(6 Pt A):750-753. DOI: 10.1016/j.jpurol.2012.08.011

14. Das A.K., Teplitsky S., Chandrasekar T., Perez T., Guo J., Leong J.Y., Shenot P.J. Stress Urinary Incontinence post-Holmium Laser Enucleation of the Prostate: a Single-Surgeon Experience. Int Braz J Urol. 2020;46(4):624-631. DOI: 10.1590/S1677-5538.IBJU.2019.0411

15. Huang H.N., Sun Y.H., Liu X., Tao W.Q. Analysis of Postoperative Urinary Incontinence and Influencing Factors of Transurethral Holmium Laser Enucleation of the Prostate. Urol Int. 2024;108(5):457-463. DOI: 10.1159/000539201

16. Coman R.A., Bschleipfer T., Al Hajjar N., Petrut B. Predictive Factors of Transient Urinary Incontinence Following Holmium Laser Enucleation of the Prostate (HoLEP): Single-Center Experience. Medicina (Kaunas). 2024;60(9):1460. DOI: 10.3390/medicina60091460

17. Kogan M.I. Male and female urinary incontinence management. Urology Herald. 2024;12(3):5-9. (In Russian). DOI: 10.21886/2308-6424-2024-12-3-5-9

18. Bogdanov D.A., Yusufov A.G., Guspanov R.I., Kotov S.V. Overactive bladder following surgical intervention for benign prostatic hyperplasia: treatment outcomes in routine clinical practice. Urology Herald. 2025;13(3):19-29. (In Russian). DOI: 10.21886/2308-6424-2025-13-3-19-29

19. Shah H.N., Mahajan A.P., Hegde S.S., Bansal M.B. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int. 2007;100(1):94- 101. DOI: 10.1111/j.1464-410X.2007.06867.x

20. Vavassori I., Hurle R., Vismara A., Manzetti A., Valenti S. Holmium laser enucleation of the prostate combined with mechanical morcellation: two years of experience with 196 patients. J Endourol. 2004;18(1):109- 112. DOI: 10.1089/089277904322836767

21. Lee H.Y., Cho S.Y., Juan Y.S., Teoh J.Y. How to optimise urinary continence in anatomical endoscopic enucleation of the prostate? Andrologia. 2020;52(8):e13621. DOI: 10.1111/and.13621

22. Nam J.K., Kim H.W., Lee D.H., Han J.Y., Lee J.Z., Park S.W. Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate. World J Mens Health. 2015;33(2):88-94. DOI: 10.5534/wjmh.2015.33.2.88

23. Cho M.C., Park J.H., Jeong M.S., Yi J.S., Ku J.H., Oh S.J., Kim S.W., Paick J.S. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn. 2011;30(7):1343-1349. DOI: 10.1002/nau.21050

24. Leach G.E., Trockman B., Wong A., Hamilton J., Haab F., Zimmern P.E. Post-prostatectomy incontinence: urodynamic findings and treatment outcomes. J Urol. 1996;155(4):1256-1259. DOI: 10.1016/s0022-5347(01)66235-9

25. Dorey G. A clinical overview of the treatment of post-prostatectomy incontinence. Br J Nurs. 2007;16(19):1194-1199. DOI: 10.12968/bjon.2007.16.19.27357

26. Anderson C.A., Omar M.I., Campbell S.E., Hunter K.F., Cody J.D., Glazener C.M. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev. 2015;1(1):CD001843. DOI: 10.1002/14651858.CD001843.pub5

27. Glazener C., Boachie C., Buckley B., Cochran C., Dorey G., Grant A., Hagen S., Kilonzo M., McDonald A., McPherson G., Moore K., N’Dow J., Norrie J., Ramsay C., Vale L. Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS): two parallel randomised controlled trials. Health Technol Assess. 2011;15(24):1-290, iii-iv. DOI: 10.3310/hta15240

28. Glazener C., Boachie C., Buckley B., Cochran C., Dorey G., Grant A., Hagen S., Kilonzo M., McDonald A., McPherson G., Moore K., Norrie J., Ramsay C., Vale L., N’Dow J. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials. Lancet. 2011;378(9788):328-337. Erratum in: Lancet. 2012;379(9814):412. DOI: 10.1016/S0140-6736(11)60751-4

29. Tibaek S., Klarskov P., Lund Hansen B., Thomsen H., Andresen H., Schmidt Jensen C., Niemann Olsen M. Pelvic floor muscle training before transurethral resection of the prostate: a randomized, controlled, blinded study. Scand J Urol Nephrol. 2007;41(4):329-334. DOI: 10.1080/00365590601183584

30. Anan G., Kaiho Y., Iwamura H., Ito J., Kohada Y., Mikami J., Sato M. Preoperative pelvic floor muscle exercise for early continence after holmium laser enucleation of the prostate: a randomized controlled study. BMC Urol. 2020;20(1):3. DOI: 10.1186/s12894-019-0570-5

31. Fink K.G., Huber J., Würnschimmel E., Schmeller N.T. The use of Duloxetine in the treatment of male stress urinary incontinence. Wien Med Wochenschr. 2008;158(3-4):116-118. DOI: 10.1007/s10354-007-0494-7

32. Noordhoff T.C., Finazzi-Agrò E., Scheepe J.R., Blok B.F.M. Outcome and complications of adjustable continence therapy (ProACTTM ) in the treatment of urinary incontinence after transurethral resection of the prostate: A multicenter study. Neurourol Urodyn. 2019;38(4):1111- 1119. DOI: 10.1002/nau.23966

33. Angulo J.C., Fonseca J., Esquinas C., Ojea A., Rodríguez A., Rabassa M., Teba F., Escribano G., Cruz F. Adjustable transobturator male system (ATOMS®) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate. Actas Urol Esp (Engl Ed). 2018;42(9):567-573. (In English, Spanish). DOI: 10.1016/j.acuro.2018.05.002

34. Friedl A., SchneeweissJ., Stangl K., Mühlstädt S., Zachoval R., Hruby S., Gründler T., Kivaranovic D., Fornara P., Lusuardi L., Brössner C. The Adjustable Transobturator Male System in Stress Urinary Incontinence After Transurethral Resection of the Prostate. Urology. 2017;109:184- 189. DOI: 10.1016/j.urology.2017.07.004

35. Parker D.C., Simhan J. Management of complications after surgical outlet reduction for benign prostatic obstruction. Can J Urol. 2015;22 Suppl 1:88-92. PMID: 26497349

36. Imamoglu M.A., Tuygun C., Bakirtas H., Yiğitbasi O., Kiper A. The comparison of artificial urinary sphincter implantation and endourethral macroplastique injection for the treatment of postprostatectomy incontinence. Eur Urol. 2005;47(2):209-213. DOI: 10.1016/j.eururo.2004.08.019

37. Silva L.A., Andriolo R.B., Atallah Á.N., da Silva E.M. Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev. 2014;2014(9):CD008306. DOI: 10.1002/14651858.CD008306.pub3

38. Hogewoning C.R.C., Meij L.A.M., Pelger R.C.M., Putter H., Krouwel E.M., Elzevier H.W. Sling Surgery for the Treatment of Urinary Incontinence After Transurethral Resection of the Prostate: New Data on the Virtue Male Sling and an Evaluation of Literature. Urology. 2017;100:187-192. DOI: 10.1016/j.urology.2016.08.060

39. Leizour B., Chevrot A., Wagner L., Droupy S., Costa P. Bandelette sousurétrale rétropubienne ajustable Remeex® dans le traitement de l’incontinence urinaire d’effort masculine: résultats à un an [Adjustable retropubic suburethral sling Remeex® in the treatment of male stress urinary incontinence: One-year results]. Prog Urol. 2017;27(4):238-243. (In French) DOI: 10.1016/j.purol.2016.11.006

40. Constable L., Abrams P., Cooper D., Kilonzo M., Cotterill N., Harding C., Drake M.J., Pardoe M.N., McDonald A., Smith R., Norrie J., McCormack K., Ramsay C., Uren A., Mundy T., Glazener C., MacLennan G. Synthetic sling or artificial urinary sphincter for men with urodynamic stress incontinence after prostate surgery: the MASTER non-inferiority RCT. Health Technol Assess. 2022;26(36):1-152. DOI: 10.3310/TBFZ0277