PD39-05 INCIDENCE AND MANAGEMENT OF PERSISTENT STRESS URINARY INCONTINENCE AFTER HOLMIUM LASER ENUCLEATION THE PROSTATE

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II1 Apr 2018PD39-05 INCIDENCE AND MANAGEMENT OF PERSISTENT STRESS URINARY INCONTINENCE AFTER HOLMIUM LASER ENUCLEATION THE PROSTATE Mihir Shah, Ali Syed, Thomas Hardacker, Alana Murphy, and Akhil Das Mihir ShahMihir Shah More articles by this author , Ali SyedAli Syed More articles by this author , Thomas HardackerThomas Hardacker More articles by this author , Alana MurphyAlana Murphy More articles by this author , and Akhil DasAkhil Das More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1917AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser enucleation of the prostate (HoLEP) is a commonly performed procedure for treatment of benign prostatic hyperplasia (BPH). Transient stress urinary incontinence (SUI) is a known phenomenon occurring in a small percentage of the patients undergoing a HoLEP. Persistent SUI after HoLEP is rare but a debilitating complication for the patient. Management of persistent SUI after HoLEP is not well described. We sought to determine the incidence and management of persistent SUI after HoLEP at our institution. METHODS A retrospective review, from an IRB approved database, of all patients that underwent a HoLEP at our institution between February 2010 and September 2017 was performed. A total of 481 patients met inclusion criteria. Data regarding SUI post procedure was collected. Continued SUI beyond 3 months after surgery was defined as persistent SUI. Transient SUI was defined as incontinence that resolved within 3 months after surgery. Each patient with persistent SUI underwent injection of periurethral bulking agent Coaptite. The technique employed involved endoscopic injection of 2-4 ml of Coaptite in the distal prostatic urethra adjacent to the verumontanum. Change in their SUI was assessed by number of pads used per day. RESULTS Of the 481 patients who underwent HoLEP, only 4 patients (0.008%) had significant persistent SUI. Transient SUI was present in roughly 15-20% of the patients. Preoperative urodynamic evaluation (UDS) of all 4 patients with persistent SUI revealed bladder outlet obstruction without any evidence of intrinsic sphincter deficiency or SUI. All 4 of these patients had significant bother from their SUI and required more than 2 pads per day. All 4 patients failed pelvic floor physiotherapy and underwent injection of periurethral bulking agent. After Coaptite injection, all 4 patients had significant improvement in their SUI, using less than 1 pad daily. This improvement in SUI after Coaptite injection was noted to last 7-12 months, with 2 patients requiring repeat injections at 7 months and 8 months respectively. Interestingly, 2 of the 4 patients with persistent SUI had neurological comorbidities, one with Multiple Sclerosis and one with Myasthenia Gravis. CONCLUSIONS Persistent SUI is a rare complication after HoLEP. Endoscopic injection of periurethral bulking agent is a viable surgical option for those patients that have bothersome persistent SUI. Preoperative UDS does not help in predicting SUI post HoLEP. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e799-e800 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mihir Shah More articles by this author Ali Syed More articles by this author Thomas Hardacker More articles by this author Alana Murphy More articles by this author Akhil Das More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...