Narmina Khanmammadova, MD, discusses findings on pelvic floor therapy before HoLEP

In this video, Narmina Khanmammadova, MD, discusses interim findings from a randomized controlled trial evaluating whether preoperative pelvic floor physical therapy (PFPT) could reduce transient stress urinary incontinence (tSUI) and accelerate continence recovery after holmium laser enucleation of the prostate (HoLEP).¹ Khanmammadova is a research coordinator at University of California, Irvine Health.

According to the authors, HoLEP is a highly effective and durable treatment for benign prostatic hyperplasia (BPH), but transient urinary incontinence remains a postoperative concern, with 20% to 40% of patients potentially experiencing tSUI. Although factors including surgeon experience, operative time, and surgical technique may influence continence outcomes, the study investigators evaluated whether beginning PFPT before surgery could provide an additional intervention.

The multicenter trial included 72 patients in the interim analysis, with 38 randomly assigned to the intervention arm and 34 to standard of care. Patients in the intervention arm began PFPT 4 weeks before HoLEP and performed 3 daily sets of 10 Kegel exercises.

Data showed that patients who initiated PFPT before surgery demonstrated numerically higher rates of full continence at 1 week compared with the standard-of-care group, at 71% vs 56%, respectively (P = .2). At 1 month, tSUI rates were also lower in the intervention group than in the standard-of-care group, at 11% vs 24% (P = 0.2). However, neither difference reached statistical significance. Postoperative American Urological Association Symptom Scores and post-void residual volumes were comparable between groups (P > .05 for both).

Khanmammadova noted that the intervention may be attractive because of its low-risk and practical nature, even as these data need further analysis, stating, “We think that this is a very easy and low-risk intervention, and it is worth considering recommending this to our patients.”

The investigators noted that additional analysis of the final cohort is needed to better define the role of PFPT in continence recovery.

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