Introduction Transient urinary incontinence remains one of the most common complications following holmium laser enucleation of the prostate (HoLEP). Recently, several studies have investigated preoperative magnetic resonance imaging (MRI)-derived anatomical parameters as potential predictors of postoperative urinary continence; however, the available evidence has not been systematically synthesized. This systematic review and meta-analysis evaluated the association between preoperative MRI-derived anatomical parameters and postoperative urinary incontinence following HoLEP. Methods A systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science from database inception to May 30, 2026. Observational studies evaluating preoperative MRI-derived anatomical parameters in patients undergoing HoLEP were included. The primary outcome was postoperative urinary incontinence. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the generic inverse variance method with a random effects model. Study quality and certainty of evidence were assessed using the Newcastle–Ottawa Scale and the GRADE approach, respectively. Results Five retrospective cohort studies comprising 800 patients met the inclusion criteria. Quantitative synthesis demonstrated that greater preoperative membranous urethral length (MUL) was significantly associated with a lower risk of postoperative urinary incontinence at 1 month (OR 0.88, 95% CI 0.84–0.93; P < 0.00001; I2 = 0%) and 3 months (OR 0.80, 95% CI 0.71–0.90; P = 0.0002; I2 = 0%). At 6 months, the pooled effect remained in the same protective direction but did not reach statistical significance under the prespecified random effects model (OR 0.76, 95% CI 0.57–1.03; <Emphasis Type="BoldItalic">P</Emphasis> = 0.08; I2 = 61%). Other MRI-derived anatomical parameters, including membranous urethral angle, periurethral sphincter complex, levator ani thickness, membranous urethral volume, minimal residual urethral length, total posterior wall of the membranous urethral sphincter, prostatic apex overlapping the membranous urethra, and intravesical prostatic protrusion length, were reported in individual studies but could not be quantitatively synthesized because of limited and heterogeneous data. Conclusions Current evidence indicates that preoperative membranous urethral length is the most consistently identified MRI-derived anatomical predictor of postoperative urinary continence following HoLEP. Longer MUL was consistently associated with a lower risk of postoperative urinary incontinence during early and intermediate follow-up.

Preoperative MRI-derived anatomical predictors of urinary incontinence after holmium laser enucleation of the prostate: a systematic review and meta-analysis

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发表日期：

2026年8月1日

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Yavuz Güler

摘要

Introduction

Transient urinary incontinence remains one of the most common complications following holmium laser enucleation of the prostate (HoLEP). Recently, several studies have investigated preoperative magnetic resonance imaging (MRI)-derived anatomical parameters as potential predictors of postoperative urinary continence; however, the available evidence has not been systematically synthesized. This systematic review and meta-analysis evaluated the association between preoperative MRI-derived anatomical parameters and postoperative urinary incontinence following HoLEP.

Methods

A systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science from database inception to May 30, 2026. Observational studies evaluating preoperative MRI-derived anatomical parameters in patients undergoing HoLEP were included. The primary outcome was postoperative urinary incontinence. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the generic inverse variance method with a random effects model. Study quality and certainty of evidence were assessed using the Newcastle–Ottawa Scale and the GRADE approach, respectively.

Results

Five retrospective cohort studies comprising 800 patients met the inclusion criteria. Quantitative synthesis demonstrated that greater preoperative membranous urethral length (MUL) was significantly associated with a lower risk of postoperative urinary incontinence at 1 month (OR 0.88, 95% CI 0.84–0.93; P < 0.00001; I2 = 0%) and 3 months (OR 0.80, 95% CI 0.71–0.90; P = 0.0002; I2 = 0%). At 6 months, the pooled effect remained in the same protective direction but did not reach statistical significance under the prespecified random effects model (OR 0.76, 95% CI 0.57–1.03; P = 0.08; I² = 61%). Other MRI-derived anatomical parameters, including membranous urethral angle, periurethral sphincter complex, levator ani thickness, membranous urethral volume, minimal residual urethral length, total posterior wall of the membranous urethral sphincter, prostatic apex overlapping the membranous urethra, and intravesical prostatic protrusion length, were reported in individual studies but could not be quantitatively synthesized because of limited and heterogeneous data.

Conclusions

Current evidence indicates that preoperative membranous urethral length is the most consistently identified MRI-derived anatomical predictor of postoperative urinary continence following HoLEP. Longer MUL was consistently associated with a lower risk of postoperative urinary incontinence during early and intermediate follow-up.