Presentation Authors: Go Anan*, Hiromichi Iwamura, Jun Ito, Yasuhiro Kaiho, Makoto Sato, Sendai, Japan
Introduction: Postoperative transient urinary incontinence is a bothersome complication of holmium laser enucleation of the prostate (HoLEP). The effect of preoperative pelvic floor muscle exercise (PFME) for early continence after HoLEP has never been reported. The aim of this study is to determine the benefit of preoperative and postoperative PFME for early recovery of continence.
Methods: A randomized, prospective study was designed. Patients who underwent HoLEP were randomized to start PFME preoperatively from 28 days before HoLEP and continue postoperatively (group A) or to start PFME postoperatively alone (group B). The primary outcome measure was self-reported continence after surgery. The condition of no incontinence was evaluated by defining complete urinary control as no pad usage. The secondary outcome measure was assessed using the quality of life instrument ICIQ-SF.
Results: Forty were randomized either to start PFME preoperatively and continue postoperatively (group A; n = 20) or to start postoperative PFME (group B; n = 20). On the patient and perioperative background, there was no difference in age, operation time, resected prostate volume, and the operator (experienced or inexperienced surgeon) in two groups. At 1 month, 35% of patients were incontinent in group A, while 45% patients were incontinent in group B (p = 0.33). At 3 months, 5% and 35% patients were incontinent in group A and B, respectively (p = 0.013). At 6 months, no patient was incontinent in both the groups. The postoperative ICIQ-SF scores were not significantly different between group A and B at both 1 month (6.5 vs. 6.4) and 3 months (3.5 vs. 4.6) after HoLEP (p = 0.67). In logistic regression analysis, patients who performed preoperative PFME had a 0.52-fold lower risk of being incontinent I month after HoLEP and a 0.10-fold lower risk of being incontinent 3 months after HoLEP.
Conclusions: It was suggested that preoperative pelvic floor muscle exercise before HoLEP may contribute to an early improvement of urinary incontinence after HoLEP.