Purpose of Review <p>The goal of this paper was to identify the factors contributing to urinary incontinence in patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia by performing a systematic review of the literature.</p> Recent Findings <p>Our search identified 40 randomized studies. Significant heterogeneity existed in defining urinary incontinence in the literature. Many factors contribute to postoperative incontinence after HoLEP, with surgical technique seeming to play the largest role in determining continence outcomes.</p> Summary <p>Refinement of surgical technique is critical to improving continence outcomes after HoLEP. Standardizing definitions of urinary incontinence will enable more reliable comparisons across studies and facilitate better-informed preoperative counseling. Continued investigation is also essential to develop interventions—whether surgical, behavioral, or pharmacologic—that enhance continence recovery and overall quality of life.</p>