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.

1.
Wei JT, Calhoun E, Jacobsen SJ: Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2005;173:1256-1261.
2.
Statistics Bureau, Ministry of Internal Affairs and Communications: Number of patients by disease in Japan 2011 - annual transitions - HWL statistics. 2011. http://www.e-stat.go.jp/SG1/estat/NewList.do?tid=000001031167 (accessed September 13, 2015).
3.
The Japanese Urological Association: Clinical guidelines for benign prostatic hyperplasia. Tokyo, RichHill Medical, 2011.
4.
Masumori N, Tsukamoto T, Kumamoto Y, Miyake H, Rhodes T, Girman CJ, Guess HA, Jacobsen SJ, Lieber MM: Japanese men have smaller prostate volumes but comparable urinary flow rates relative to American men: results of community based studies in 2 countries. J Urol 1996;155:1324-1327.
5.
Tsukamoto T, Masumori N: Epidemiology and natural history of benign prostatic hyperplasia. Int J Urol 1997;4:233-246.
6.
Masumori N, Kamoto T, Seki N, Homma Y; Committee for Clinical Guideline for Benign Prostatic Hyperplasia: Surgical procedures for benign prostatic hyperplasia: a nationwide survey in Japan. Int J Urol 2011;18:166-170.
7.
Gilling PJ, Kennett K, Das AK, Thompson D, Fraundorfer MR: Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J Endourol 1998;12:457-459.
8.
Fraundorfer MR, Gilling PJ: Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 1998;33:69-72.
9.
Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'dow J, Nordling J, de la Rosette JJ; European Association of Urology: EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013;64:118-140.
10.
Masui K, Yoshimura K, Nishiyama H, Okuno H, Ogawa O: Transition in type of surgery for benign prostatic hyperplasia: a multi-institutional study in Japan. LUTS 2011;3:104-108.
11.
Buckley BS, Lapitan MC, Glazener CM; MAPS Trial Group: The effect of urinary incontinence on health utility and health-related quality of life in men following prostate surgery. Neurourol Urodyn 2012;31:465-469.
12.
Elmansy HM, Kotb A, Elhilali MM: Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate? J Urol 2011;186:1977-1981.
13.
Lerner LB, Tyson MD, Mendoza PJ: Stress incontinence during the learning curve of holmium laser enucleation of the prostate. J Endourol 2010;24:1655-1658.
14.
Cho MC, Park JH, Jeong MS, Yi JS, Ku JH, Oh SJ, Kim SW, Paick JS: Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn 2011;30:1343-1349.
15.
Endo F, Shiga Y, Minagawa S, Iwabuchi T, Fujisaki A, Yashi M, Hattori K, Muraishi O: Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence. Urology 2010;76:1451-1455.
16.
Van Kampen M, Geraerts I, De Weerdt W, Van Poppel H: An easy prediction of urinary incontinence duration after retropubic radical prostatectomy based on urine loss the first day after catheter withdrawal. J Urol 2009;181:2641-2646.
17.
Ates M, Teber D, Gozen AS, Tefekli A, Hruza M, Sugiono M, Erdogan S, Rassweiler J: A new postoperative predictor of time to urinary continence after laparoscopic radical prostatectomy: the urine loss ratio. Eur Urol 2007;52:178-185.
18.
Sato Y, Tanda H, Nakajima H, Nitta T, Akagashi K, Hanzawa T, Tobe M, Haga K, Uchida K, Honma I: Simple and reliable predictor of urinary continence after radical prostatectomy: serial measurement of urine loss ratio after catheter removal. Int J Urol 2014;21:647-651.
19.
Saito S, Namiki S, Numahata K, Satoh M, Ishidoya S, Ito A, Arai Y: Relevance of postcatheter removal incontinence to postoperative urinary function after radical prostatectomy. Int J Urol 2006;13:1191-1196.
20.
Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT: The American urological association symptom index for benign prostatic hyperplasia. The measurement committee of the American urological association. J Urol 1992;148:1549-1557.
21.
Homma Y, Tsukamoto T, Yasuda K, Ozono S, Yoshida M, Shinji M: [Linguistic validation of Japanese version of International Prostate Symptom Score and BPH impact index]. Nihon Hinyokika Gakkai Zasshi 2002;93:669-680.
22.
Homma Y, Yoshida M, Seki N, Yokoyama O, Kakizaki H, Gotoh M, Yamanishi T, Yamaguchi O, Takeda M, Nishizawa O: Symptom assessment tool for overactive bladder syndrome - overactive bladder symptom score. Urology 2006;68:318-323.
23.
Wolters U, Wolf T, Stützer H, Schröder T: ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996;77:217-222.
24.
Hirayama T, Shitara T, Fujita T, Kubo S, Iwamura M, Baba S: Corroboration of usefulness of the hand-piece inverse technique in morcellation. Jpn J Endourol ESWL 2010;23:133-137.
26.
Bulut S, Ozden C, Aktas BK, Deren T, Tagci S, Gokkaya CS, Baykam MM, Memis A: Effects of medical therapy or surgery on prostatic and bladder resistive indices in patients with benign prostatic hyperplasia. Urol Int 2015;94:181-186.
27.
Gabr AH, Gabr MF, Elmohamady BN, Ahmed AF: Prostatic artery embolization: a promising technique in the treatment of high-risk patients with benign prostatic hyperplasia. Urol Int 2016, Epub ahead of print.
28.
Chen Q, Chen YB, Wang Z, Peng YB, Zheng DC, Cai ZK, Li WJ, Zhou J: An improved morcellation procedure for holmium laser enucleation of the prostate. J Endourol 2012;26:1625-1628.
29.
Lee SH, Choi JI, Moon KY, Na W, Lee JB: Holmium laser enucleation of the prostate: modified morcellation technique and results. Korean J Urol 2012;53:779-784.
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