Urinary Incontinence: Outcomes & Complications

Moderated Poster Session

MP3-18 - Early outcomes with immediate postoperative pelvic floor therapy (PFPT) after Holmium Laser Enucleation of the Prostate (HoLEP).

Presenting Author(s)

• TL

  Tim Large, MD

  Endourology Fellow
  Indiana University School of Medicine

Author(s)

• 

  Blake Anderson

  Endourology Fellow
  Indiana University School of Medicine
• JH

  Joshua Heiman

  Medical Student
  Indiana University School of Medicine
• 

  James Lingeman

  Professor
  Indiana University School of Medicine
• 

  Amy Krambeck

  Professor
  Indiana University School of Medicine

Introduction & Objective : Long term urge and stress urinary incontinence (SUI) is rarely seen after HoLEP. However, short-term temporary incontinence is common.  At our institution, patients are provided with literature on pelvic floor exercises to expedite recovery of continence postoperatively. Despite this, we suspect that early instruction by a physical therapist, specializing in PFPT, improves early return of continence and overall patient satisfaction. Therefore, every patient is offered instruction by our pelvic floor therapist after their catheter has been removed on post-operative day one from their HoLEP procedure.

Methods : This is a retrospective review of 262 patients who underwent HoLEP between March 1^st and September 1^st 2017. 80 patients consented to participate in our prospectively maintained HoLEP database and responded to our 6-week postoperative questionnaire. Of these patients 30 underwent PFPT after the catheter was removed on postoperative day 1. This involved instruction from our PFPT specialist on techniques to contract the pelvic floor in isolation without use of abdominal, gluteal or hip muscles while in the hook-laying, sitting, standing or squatting position. Patients responded to questionnaire consisting of international continence society questionnaire (ICS), AUA symptom score, BPH index and michigan incontinence symptom index (MISI) 6 weeks after HoLEP. Patients were asked if they wore pads, the number of pads, and the number of weeks until they regained their continence.

Results : Baseline demographics between the PFPT and non-PFPT is shown in table 1. Though no statistical significance was seen, there was a trend, for PFPT versus non-PFPT, toward decreased number of people wearing pads (37% vs 48%), less time to continence (4.8 vs 5.1), and very satisfied (69% vs 50%).

Conclusions : Although improvements in the short-term post-HoLEP continence was demonstrated with PFPT, these findings were not statistically significant.   A larger scale prospective study is needed to discern if these differences are clinically significant in order to justify the cost of PFPT postoperatively.