Abstract
BackgroundTransient postoperative urinary incontinence is a bothersome complication of holmium laser enucleation of the prostate (HoLEP). The effects of preoperative pelvic floor muscle exercise (PFME) for early recovery of continence after HoLEP have never been elucidated. The aim of this study was to determine the benefit of preoperatively started PFME for early recovery of continence after HoLEP.MethodsWe randomly assigned patients to start PFME preoperatively and continue postoperatively (group A) or start PFME no earlier than the postoperative period (group B). The primary outcome was time to complete urinary control, defined as no pad usage. The secondary outcome was measured using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. Univariate and multivariate analyses were performed to identify parameters associated with recovery of continence after HoLEP.ResultsSeventy patients were randomized across groups A (n = 35) and B (n = 35). Patients’ characteristics were not different between groups A and B. The postoperative urinary incontinence rate significantly decreased in group A compared with that in group B at 3 months postoperatively [3% vs. 26% (P = 0.01)]. However, there were no significant differences between groups A and B at 3 days [40% vs. 54% (P = 0.34)], 1 month [37% vs. 51% (P = 0.34)], and 6 months [0% vs. 3% (P = 1.00)] postoperatively, respectively. The postoperative ICIQ-SF score was not significantly different between groups A and B at any time point postoperatively. In univariate analysis, patients who performed preoperative PFME had a 0.56-fold lower risk of urinary incontinence 1 month after HoLEP and a 0.08-fold lower risk of urinary incontinence 3 months after HoLEP.ConclusionsPreoperatively started PFME appears to facilitate improvement of early urinary continence after HoLEP.Trial registrationThe study was registered with the University Hospital Medical Information Network Clinical Trials Registry in Japan (UMIN000034713); registration date: 31 October 2018. Retrospectively registered.
Highlights
Transient postoperative urinary incontinence is a bothersome complication of holmium laser enucleation of the prostate (HoLEP)
Holmium laser enucleation of the prostate (HoLEP) is widely used as a minimally invasive surgical procedure because it can be performed in patients with large-sized prostatic hyperplasia and is associated with lower volumetric blood loss and shorter periods of indwelling catheterization and hospitalization than transurethral resection of the prostate (TURP) [2]
Among the patient and perioperative background characteristics, there were no differences in age, body mass index (BMI), international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), Incontinence Questionnaire-Short Form (ICIQ-SF) score, prostate volume, operation time, enucleate prostate weight, diabetes mellitus status, and G8 score between the two groups (Table 1)
Summary
Transient postoperative urinary incontinence is a bothersome complication of holmium laser enucleation of the prostate (HoLEP). The effects of preoperative pelvic floor muscle exercise (PFME) for early recovery of continence after HoLEP have never been elucidated. Postoperative transient urinary incontinence has been reported as a bothersome complication of HoLEP in 16–44% patients within 3 months [3,4,5]. Pelvic floor muscle exercise (PFME) is one of the physiotherapies used for recovery of continence after prostate surgery.
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