Introduction: Select patients with preoperative urgency and/or urge urinary incontinence, along with benign prostatic hyperplasia (BPH), may require post-holmium laser enucleation of the prostate (HoLEP) anticholinergic, B3 agonist, or intravesical Botox. Consideration of concurrent bladder Botox during HoLEP may help reduce postoperative urgency, urge urinary incontinence, and need for incontinence treatments. Our primary objectives were to assess whether concurrent bladder Botox during HoLEP was safe while improving urgency.

Methods: We prospectively examined 10 consecutive patients enrolled within our institutional review board-approved clinical registry that underwent HoLEP and bladder Botox (200 units) at our center from July to October 2021. Patient perioperative course was examined in the context of urgency, incontinence, incontinence products, and complications. Continuous variables were expressed as median (interquartile range [IQR]) and mean (range), with heteroscedastic two-tailed T-test and Fisher's exact test. Significance was set at p<0.05.

Results: We examined 10 patients of median age 72 years (IQR 68–75), boys mass index 30 (28–38), preoperative prostate-specific antigen 2.3 (1.4–5.3), prostate volume 102 mL (60–125) (four computed tomography, four magnetic resonance imaging, three digital rectal exam), American Urological Association Symptom Score 24 (23–27), Michigan Incontinence Symptom Index (MISI) severity 13 (12–26), and MISI bother 4 (2–6). All patients had preoperative urgency and urinary incontinence with a mean number of daily incontinence products of 3.1 (range 0–11) and 5/10 having a history of anticholinergic ± B3 agonist medication use. Only 2/10 patients had prior BPH surgery (1 transurethral resection of the prostate [TURP], 1 TURP and photoselective vaporization of the prostate). Nine patients completed a one-week postoperative followup, with 4/9 (44%) being continent. One week postoperatively, the mean incontinence product use improved (3.1 vs. 0.75, p=0.03). Within three months, 1/9 patients had ongoing urinary incontinence (one pending followup) with improved MISI bother (4 vs. 1, p=0.002). There was one 90-day Clavien-Dindo ≥IIIa complication. No patients had urinary retention within 30 days.

Conclusions: In this single-center feasibility study, concurrent urinary bladder Botox during HoLEP was safe in select patients and improved urgency, urge urinary incontinence, and incontinence product usage.