(217) IMPACT OF PROSTATE VOLUME AND PREOPERATIVE URINARY RETENTION ON URINARY INCONTINENCE FOLLOWING HOLMIUM LASER ENUCLEATION OF PROSTATE

Abstract Introduction HOLEP is an increasingly popular modality for men with BPH and associated LUTS. While studies show that post-operative urinary incontinence returns to baseline following HOLEP, existing research has not been completed utilizing comprehensive validated UI questionnaires. In addition, the associations between prostate size or pre-operative retention on post-operative incontinence are not well studied. Current theories include the notion that larger prostate size (with retention as a correlate) may lead to increased manipulation and damage to the external sphincter during the procedure. Confirmation or negation of such risk factors for post-operative incontinence may guide surgeons in pre-operative counseling for shared-decision-making to reach patient satisfaction. Objective Our objective was to evaluate the impact of prostate size and preoperative retention on postoperative incontinence by utilizing the AUASS and Michigan-Incontinence Symptom Index (MISI) before and 1 and 6 months after HOLEP. MISI is a validated UI questionnaire with score of 0-32, with higher score indicating worse symptoms. Methods We retrospectively reviewed 627 males who underwent HOLEP at our institution by a single surgeon between 2014-2022, of which were included. We excluded 300 patients without both pre and 6-month post-operative MISI scores; 15 others were missing prostate size. Our primary outcome was ISI score comparison. AUASS were also compared to confirm validity of our results. Prostate size was grouped into quartiles (Q1 = <50 g, Q2 = 51-80, Q3 = 81-120, Q4 = >120) and retention was categorized into “with” or “without” prior to surgery. Retention was defined as patients with any form of catheterization. Wilcoxon rank test was used to evaluate the association of postoperative urinary symptoms with prostate size and retention. Results Of 627 subjects, median age was 70 years old and median prostate size was 81 grams, with range of 16.6 and 350. 24% of patients were identified to have urinary retention. MISI score medians are 3 points at baseline, 11 points and 1 month, and 4 points at 6 months. MISI scores from baseline to 6-month assessment were not associated with prostate size (p = 0.2) nor pre-operative retention (p > 0.8). Changes at 1-month assessment were also not associated with either variable (Fig. 2a, 2b). Conclusions With utilization of validated urinary incontinence questionnaires, we confirm that urinary incontinence may worsen in the immediate post-operative period and return to baseline by 6 months. Unlike other studies, we conclude that neither prostate size nor preoperative urinary retention had an impact on self-reported incontinence. Thus, such factors may not be critical to include in patient selection for HOLEP when considering post-operative incontinence risks. Disclosure No.