Best Practices & Benign Disease
Introduction & Objective :
Transient SUI can occur in 15-20 % of patients after HoLEP. Transient SUI can be a frustrating temporary outcome for patients undergoing HoLEP. We reviewed the charts of patients that had transient SUI post HoLEP and tried to identify factors that may lead to transient SUI. By identifying risk factors associated with transient SUI, we will be able to counsel our patients better and hopefully reduce their frustration level.
A retrospective review, from an IRB approved database, of all 515 patients that underwent a HoLEP at our institution between January 2012 and December 2017 was performed. Transient SUI after HoLEP was defined as any leakage of urine lasting up to 3 months post-operative date. Patients were stratified by gland size determined by transrectal ultrasound (TRUS) and whether they were catheter dependent. Catheter dependency was either clean intermittent catheterizations (CIC) or continuous urethral drainage catheter. Prostate gland size was either greater than 100 grams or less. Patients were seen for follow-up at 2 weeks, 6 weeks, and 3 months post-operative date. Univariate analysis was performed for baseline demographics.
Results : Out of the 515 patients analyzed, 52 (10.1%) developed transient SUI. Stress urinary incontinence resolved in 46 out of 52 patients (88.5%) within the first 6 weeks post-operatively and 6 out of 52 (11.5%) within 6 weeks to 3 months. TRUS was obtained in 330 out of 515 patients, of which 123 (37.3%) patients had prostate size greater than 100g. 38/52 or 72% with transient SUI were catheter dependent prior to their HoLEP. 86% of patients with transient SUI had larger than normal prostate size. In patients with resolution of transient SUI within 6 weeks, 84.8% had prostate size larger than 100g while 100% of patients with resolution between 6 weeks to 3 months had prostate volume greater than 100g. Mean prostatic gland volume on TRUS was 93.6 ± 56.6 grams for all patients. The average age and body mass index (± standard deviation) was 70.5 ± 8.5 years and 30 ± 11.9, respectively.
Conclusions : The majority of patients with transient stress urinary incontinence fully recover their control of their bladder within the first 6 weeks. Patients with prostate sizes greater than 100 g and catheter dependent urinary retention have a higher risk of transient SUI. These patients should be counseled appropriately to reduce their frustration level during their post-operative course. Currently, we are investigating the use of perioperative pelvic floor rehabilitation to hopefully reduce or eliminate transient SUI post HoLEP.