Practical Index of Urinary Incontinence Following Holmium Laser Enucleation of the Prostate: A Case-Series Study of the 24-Hour Pad Test Immediately after Catheter Removal.

Introduction: Epidemiological data regarding complications after holmium laser enucleation of the prostate (HoLEP) are scarce in Japan. We examined the associations of the 24-hour pad test results immediately after HoLEP with continence acquisition at 3 months postoperatively.

Materials And Methods: In this hospital-based case-series study, we reviewed medical charts of 341 patients without catheterization and 150 patients with catheterization at the time of surgery. The 24-hour pad test was conducted immediately after catheter removal to measure the leakage weight. Subjects were divided into 2 groups: leakage weight = 0 g (negative) and >0 g (positive). Urinary incontinence (UI) at 3 months postoperatively was self-reported by patients.

Results: Significant relationships were observed between pad test positivity and UI at 3 months postoperatively and between the pad test weight and the timing of continence acquisition in patients with and without catheterization. In multivariate analyses, the pad test positivity was associated significantly with the Overactive Bladder Symptom Score and enucleated tissue weight in patients without perioperative catheterization and with age in patients with catheterization.

Conclusions: The 24-hour pad test immediately after catheter removal could indicate the need for early and active intervention to prevent continuous postoperative UI. Patients' symptoms and clinical items predictive of test positivity should be carefully assessed.