Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long‐term follow‐up
- 9 May 2006
- journal article
- Published by Wiley in BJU International
- Vol. 97 (6), 1234-1241
- https://doi.org/10.1111/j.1464-410x.2006.06185.x
Abstract
OBJECTIVES To investigate the incidence of urinary incontinence and its development over time, to compare the effects of alternative definitions on the incontinence rate and to explore risk factors for incontinence after radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. PATIENTS AND METHODS Urinary continence was assessed using a questionnaire administered by a third party in 1144 consecutive patients after undergoing RRP at our department from January 1986 to December 2001. Overall, 985 men (86%) were suitable for evaluation (mean age 64.5 years, mean follow-up 95.5 months). We compared the effects of three definitions on the actuarial rate of continence: (1) no or occasional pad use; (2) 0 or 1 pads used daily, but for occasional dribbling only; (3) 0–1 pads daily. The time to recovery of continence was defined as the date on which the patient met the continence definitions. The impact of incontinence on health-related quality of life (HRQoL) was also evaluated. Univariate and multivariate analyses were used to identify predictors of incontinence, using data gathered prospectively. RESULTS At the last follow-up at 24 months after RRP, 83%, 92.3% and 93.4% of men achieved continence according to definitions 1, 2 and 3, respectively. The difference in time to recovering continence was significant for definition 1 compared to the others (P < 0.001). Most men using 1 pad/day complained of occasional dribbling only (89.3%), considered themselves continent (98%) and their HRQoL was not as seriously affected as those requiring ≥ 2 pads/day. Men continent (by definition 3) at 2 years had an actuarial probability of preserving continence of 72.2% at the last follow-up. On multivariate analysis the age at surgery (P = 0.009), anastomotic stricture and follow-up interval (both P < 0.001) were independent prognostic factors. Bilateral neurovascular bundle resection was another independent predictive factor (P = 0.03) in the subset of the last 560 men with available data on surgical technique. The reduction in the incidence of incontinence over time was as high as 86%. CONCLUSIONS Continence improves progressively until 2 years from RRP but some patients can become incontinent later. The criterion of pad use discriminates well between men with a limited reduction in their QoL (no or one pad used) and those with a markedly affected QoL (≥2 pads/day). It could be clinically valid to consider users of 1 pad/day as continent. Age, bilateral neurovascular bundle resection and anastomotic stricture are significant risk factors for incontinence. There was a marked trend for the incidence of incontinence and anastomotic stricture to decrease with time.Keywords
This publication has 50 references indexed in Scilit:
- 5-YEAR URINARY AND SEXUAL OUTCOMES AFTER RADICAL PROSTATECTOMY: RESULTS FROM THE PROSTATE CANCER OUTCOMES STUDYJournal of Urology, 2005
- INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS OF RADICAL RETROPUBIC PROSTATECTOMY IN A CONSECUTIVE SERIES OF 1,000 CASESJournal of Urology, 2001
- INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS OF RADICAL RETROPUBIC PROSTATECTOMY IN A CONSECUTIVE SERIES OF 1,000 CASESJournal of Urology, 2001
- ASSESSMENT OF EARLY CONTINENCE RECOVERY AFTER RADICAL PROSTATECTOMY:Journal of Urology, 2001
- URINARY CONTINENCE AND PATHOLOGICAL OUTCOME AFTER BLADDER NECK PRESERVATION DURING RADICAL RETROPUBIC PROSTATECTOMY: A RANDOMIZED PROSPECTIVE TRIALJournal of Urology, 2001
- PROSPECTIVE ASSESSMENT OF PATIENT REPORTED URINARY CONTINENCE AFTER RADICAL PROSTATECTOMYJournal of Urology, 2000
- DIFFERENCES IN SEXUAL FUNCTION AND QUALITY OF LIFE AFTER NERVE SPARING AND NONNERVE SPARING RADICAL RETROPUBIC PROSTATECTOMYJournal of Urology, 2000
- Risk Factors for Urinary Incontinence after Radical ProstatectomyJournal of Urology, 1996
- Endoscopic Evaluation and Treatment of Anastomotic Strictures After Radical Retropubic ProstatectomyJournal of Urology, 1996
- Endoscopic Evaluation and Treatment of Anastomotic Strictures After Radical Retropubic ProstatectomyJournal of Urology, 1996