Feasibility and Utility of a Prehabilitation Program for Use in Patients With Benign Prostatic Hyperplasia Who Have Elected to Undergo Holmium Laser Enucleation of the Prostate (HoLEP).

Feasibility will be assessed through a feasibility questionnaire administered only to participants in the intervention group prior to surgery. This questionnaire is a modified version of a previously established system usability scale which consists of 10 questions assessing the feasibility of the program which participants will rate on a 1-5 Likert scale. Four additional yes/no questions regarding feasibility for further assessment. Feasibility will also be assessed based on recruitment (with a goal of 30% of patients approached based on previous studies), adherence to the exercise protocol (with a goal of 70% adherence based on previous studies), and retention through the full 12-weeks of the intervention (with a goal of 80% based on previous studies.

Safety will be assessed through a modified version of safety questionnaires used in previously reported exercise and counselling studies. This will consist of 8 questions (graded on a 0-10 Likert scale) assessing the side effects of exercise programming, 4 questions (graded on a 0-10 Likert scale) assessing the side effects of mental health supports, and a question assessing adverse events. Any adverse events would be reported and graded minor (Grade ≤1 - not requiring medical intervention) or serious (Grade ≥2 - requiring medical intervention) based on previously established National Health Institute criteria.

The IPSS is a 7 question screen for lower urinary tract symptoms with each question graded on a 0-5 Likert scale. Greater scores indicate more severe dysfunction with the following cutoffs: mild (0-7), moderate (8-19), or severe (20-35).

The M-ISI is a 10 item assessment of urinary incontinence symptoms with questions 1-8 being the total severity and questions 9 and 10 being the bother subsection of the questionnaire. Each question is graded on a 0-4 Likert scale with greater scores indicating more severe incontinence.

The SHIM is a 5-item assessment of erectile dysfunction severity with each question scored on a 0-5 Likert scale and higher scores indicating better erectile function. The following score cutoffs are used to describe dysfunction: 1-7: Severe ED, 8-11: Moderate ED, 12-16: Mild to Moderate ED, 17-21: Mild ED, 22-25: Normal Function.

The MSHQ-EjD is a 4-item assessment of ejaculatory dysfunction which is broken into a function score for the first 3 questions and a bother score for the last question. Each question is graded on a 0-5 Likert scale with higher scores indicating better ejaculatory function.

The EQ-5D-5L is a 6-item assessment of quality of life. The first 5 items are graded on a 1-5 Likert scale with higher scores indicating worse quality of life. The last item is a 0-100 rating of overall health status with higher scores indicating better health.

This is a questionnaire the investigators designed with yes/no questions to assess whether patients are experiencing any incontinence. Pre-surgery, the questionnaire is divided based on catheterization status - if a participant has a catheter it asks whether they had incontinence prior to catheterization and if a participant does not have a catheter it asks whether they currently have incontinence. Post-surgery, the questionnaire assesses whether the participant still has incontinence and if they report they do not, asks which week after surgery they stopped experiencing incontinence.

This is a 7-item measure which collects information regarding the minutes of physical activity performed per week across different domains including: walking, mild activity, moderate activity, and strenuous activity. While patients are participating in the prehabilitation program an item will also be added for participants to report their adherence to home pelvic floor strengthening exercises and the questionnaire will be modified for them to report their 3-week physical activity average rather than only for a single week. This measure assesses minutes of physical activity per week so the minimum value is 0 minutes and the maximum value is 10080 minutes with greater values representing more physical activity. Each minute also has a multiplier applied for the metabolic equivalent of the task (METs) in order to generate a weekly number of METs. Again higher numbers are associated with more physical activity.

Once pathology is available the weight of the prostate tissue resected in grams will be recorded.

Prior to the procedure, imaging and cystoscopy notes will be reviewed to obtain an estimate of prostate size. In the case of conflicting sizes reported, the most recent size on imaging will be recorded.

The number of days each patient was catheterized after their HoLEP procedure.

Any complications which occur during the surgery or post-operatively while still admitted will be recorded.

All complications relating to BPH requiring an emergency department visit or hospital admission will be recorded including the type of complication and duration of stay in the case of an admission.

All complications relating to the HoLEP procedure or BPH after discharge from the hospital following HoLEP procedure will be recorded if requiring an emergency department visit or admission to hospital including the type of complication and duration of stay if admitted.

The number of days admitted for the HoLEP procedure will be recorded.

All available post-void residuals will be recorded, this includes pre-operatively if performed as well as the post-void residual typically collected at discharge. If post-void residual is obtained at any post-operative clinic visits then this will be recorded as well.