Severe Incontinence After Radical Prostatectomy Improved Over the Last Decade, Although Advances Needed to Further Improve Outcomes

Severe incontinence in patients after radical prostatectomy improved with advances in surgical and postoperative care over the last decade, although more changes are needed to improve other urinary outcomes such as good urinary function, no incontinence and social incontinence, according to recent study findings.

“This study provides insight into the understanding of the improvement in patient outcomes after prostate surgery, specifically in radical prostatectomy,” said Dr. Behfar Ehdaie, senior author on the study and an associate professor at Memorial Sloan Kettering Cancer Center in New York in an interview with CURE®.

In the study published in Cancer, the researchers evaluated whether the advances in radical prostatectomy have affected patient-reported outcomes over time in 3,945 patients who underwent the procedure. Patient-reported outcomes consisted of four urinary function outcomes at six and 12 months after radical prostatectomy including good urinary function, no incontinence, social continence (using one or less pads per day) and severe incontinence (using three or more pads per day).

Between 2008 and 2019, excellent urinary outcomes were reported and were overall very good, Ehdaie mentioned, but there was no consistent improvement observed over time.

Good urinary function was reported by 3,142 patients (80%) at the start of the study, 1,896 patients (61%) at six months and 2,207 patients (70%) at 12 months. Social incontinence was reported by 2,676 patients (86%) at six months and 2,870 patients (91%) at 12 months.

Additionally, at six and 12 months, 1,650 patients (53%) and 2,077 patients (66%) reported using no pads, respectively.

Ehdaie explained that these results add to current literature on patient outcomes and suggests that they are somewhat successful in achieving good urinary control. For patients, it adds a second layer to focus on measures that can be taken place outside the operating room to improve outcomes.

“Our conclusion from that was beyond focusing on surgical techniques, advancements in technology and how we do surgery, we should revaluate and look at better ways to prepare patients for surgery and do procedures or develop ways for patients to do rehabilitation of their pelvic floor muscles to improve continence after surgery,” Ehdaie said.

At six months 177 patients (5.7%) reported having severe incontinence compared with 110 patients (3.5%) reporting at 12 months, demonstrating a clinical improvement, Ehdaie said. These patients are most affected by urinary control, he added, and this conclusion is reassuring for these patients because they are more high risk.

Researchers also performed an analysis, which suggested that more frequent pad usage at 12 months increase over time and the probability of no incontinence decreased from 76% in 2011 to 69% in 2017.

“This is not a study to conclude there has been no improvements in urinary control after surgery. It’s really suggesting overall assessment of urinary control is difficult to detect small differences, especially when the outcomes have improved, especially before the last decade due to refinements in surgical technique,” Ehdaie concluded.

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