ATLANTA, GA USA (UroToday) - Urinary incontinence (UI) is a common complication of surgical treatments for prostate cancer and radical prostatectomy (RP), with a potentially significant impact on quality of life. Surgical options for severe postprostatectomy incontinence include endoscopic bulking agents, male urethral slings, and the artificial urinary sphincter (AUS).
The authors' objectives were to identify predictors of these procedures and describe trends in their use over time. They used the Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, and identified men aged 66 years or older with prostate cancer who had open or minimally-invasive RP from 2000 through 2007.
The primary outcome was receipt of an incontinence procedure, identified by Medicare claims, for a bulking agent, male sling, or AUS. Demographic and clinical predictors of incontinence procedures were identified using multivariable logistic regression.
The authors identified 16,348 men who had RP, including 3,523 who had a minimally-invasive prostatectomy (22%). Overall, 1,057 men (6%) received at least one of the incontinence procedures, with similar claims irrespective of having had an open radical prostatectomy or a LRP or RRP. Older age, white race, residence in the South, and more comorbidity were associated with greater odds of having incontinence surgery, while non-metropolitan residence was associated with lower odds. Of those who had any incontinence surgery, 163 (15%) had more than one type of procedure. Thirty-nine percent of men receiving an endoscopic bulking agent also required a sling and/or AUS, and 13% of men receiving a sling also had an AUS. For 34% of those who had any incontinence surgery, AUS was the only procedure performed. The median time from prostatectomy to incontinence surgery was 20 months in 2000, which increased to 29 months in 2003, and decreased thereafter to 16 months in 2007.
Radical prostatectomy carries a risk of urinary incontinence that may ultimately require surgical intervention. In this population-based cohort of older patients, only 6% had an incontinence procedure following prostatectomy, while 94% did not have any surgical intervention. The authors conclude that those who had surgical interventions may have been men who had the most severe or persistent post-prostatectomy incontinence, however they also indicate that the low utilization rate observed may reflect underuse of potentially beneficial procedures. Men with persistent post-prostatectomy incontinence should be informed of the risks and benefits of available treatment options and counseled to make a decision that is consistent with their values and preferences. Urinary incontinence has been demonstrated to negatively impact patients' HRQOL. Irrespective of the patient's age or region of care, post-prostatectomy urinary incontinence should be assessed in patient follow-up.
Presented by Philip H. Kim, Laura C. Pinheiro, Coral L. Atoria, Jaspreet S. Sandhu, and Elena B. Elkin at the American Urological Association (AUA) Annual Meeting - May 19 - 23, 2012 - Georgia World Congress Center - Atlanta, GA USA
