Describing Incontinence After Radical Prostatectomy

By Patrick Daly - Last Updated: December 2, 2022

Persistent stress urinary incontinence (UI) following a radical prostatectomy (RP) is a highly burdensome complication for patients with prostate cancer. Avery Braun and investigators sought to describe the incidence of incontinence procedures, as well as changes in urinary function, urinary bother, and work status in the year following RP.

During a presentation at the 23rd Annual Meeting of the Society of Urologic Oncology, Braun said their analysis suggested that UI may develop in up to 11% of patients at 1 year after RP. The intervention rate for UI within 10 years was only 1.4% despite its observed impact on urinary quality of life.

This longitudinal analysis included 5742 men (mean age, 61 years) from the Cancer of the Prostate Strategic Urologic Research Endeavor registry who received primary RP between 1990 and 2020. Cases of UI were defined as self-reported use of more than 1 pad a day at 1 year post-RP, and subsequent UI procedures were assessed via Current Procedural Terminology (CPT) codes for related equipment.

Incontinence After RP Is Largely Untreated

Of the cohort, 641 (11%) met the 1-year UI criteria. Reportedly, a greater number of patients with UI received open (93% vs 7%) and non–nerve-sparing RP (62% vs 38%) compared with those without UI. Additionally, the authors observed significantly greater reductions in urinary function (-42.6 vs -11.7) and bother (-25.5 vs -2.7) in the UI group (P<.01).

In the 1.4% of patients with UI who underwent incontinence procedures at 10 years, median time to UI procedure after RP was 36 months (interquartile range, 12-74 months). Reviewed CPT codes were 52.4% artificial urinary sphincter, 15.8% urinary sling, 6.3% both, and 25.4% unspecified.

Braun and colleagues concluded their study “suggests that a significant number of men may have long-term, untreated incontinence, and even those who undergo procedures to manage it may not have it in a timely fashion.”