Presentation Authors: Seth Teplitsky*, Thenappan Chandrasekar, Tomy Perez, Jenny Guo, Ali Syed, Patrick Shenot, Akhil Das, Philadelphia, PA
Introduction: Transient stress urinary incontinence (tSUI) can cause distress for patients undergoing prostate reducing procedures, including Holmium laser enucleation of the prostate (HoLEP). We aim to identify the incidence and predictors of tSUI following HoLEP in a single-institution, single-surgeon experience.
Methods: We performed a retrospective review of 515 patients who underwent HoLEP at our institution by a single-surgeon (AD) between 2012 and 2017. All patients were assessed for incontinence at each visit before and after HoLEP, including an International Prostate Symptom Score (IPSS) questionnaire. Patients were stratified by preoperative transrectal ultrasound gland size (100g) and preoperative catheter dependency. Patients were seen for follow-up at two weeks, six weeks, and three months postoperatively. Univariate analysis was performed for baseline demographics to assess for predictors of tSUI; multivariate logistic regression analysis was run based on significant variables from univariate analysis.
Results: 53/515 patients (10.3%) developed tSUI. Resolution occurred in 47/53 patients (88.6%) within the first six weeks and 6/53 (11.3%) between 6 weeks to 3 months. 38/53 (71.6%) with incontinence were catheter dependent before HoLEP. 84.8% of men with >100g prostates had incontinence resolution within six weeks. Mean prostatic volume on ultrasound was 146.9 cc in those with tSUI compared to 93.6 cc (p = < 0.0001). Univariate analysis showed a significant increase in laser energy used (p = < 0.0001), laser &[Prime]on&[Prime] time (p = 0.0380), resected prostate weight (p = 0.0010), and IPSS score both overall (p = 0.0274) as well as on the QOL question (p = 0.0033) in the patients with transient incontinence compared to control. Multivariate analysis for tSUI risk assessment showed significance only for resected prostate weight (HR 1.019, 95% CI 1.006-1.033, p < 0.05).
Conclusions: The majority of patients with tSUI recover within the first 6 weeks following HOLEP. Prostate size > 100g and catheter dependency are associated with an increased risk of developing tSUI. Larger prostate volume is an independent predictor of tSUI.