Surgery avoidable for some with persistent incontinence after prostatectomy

By Sally Robertson, B.Sc.Aug 1 2012

Researchers have identified factors that could help determine whether patients who have not recovered urinary continence (UC) more than 1 year after undergoing radical prostatectomy (RP) should undergo further surgery.

The most important factors associated with UC recovery at this stage are severity of incontinence and the patient's age at surgery, say Sang Eun Lee (Seoul National University Bundang Hospital, Korea) and colleagues.

Additional improvement of incontinence has been found to be minimal beyond 1 year after surgery, by which time it is considered appropriate to proceed with surgical treatment for persistent incontinence, even though there are no standardized guidelines on this issue, explains the team.

In addition, there is a paucity of literature on the predictive factors for the further recovery of UC subsequent to the first year after surgery.

In an analysis of available data for 708 men who underwent RP for prostate cancer, 73 (10.3%) patients failed to recover UC within 1 year after surgery.

During a further 42-month follow-up period, 41 (56.2%) of these patients did recover UC, within a mean time of 15.4 months.

Multivariate analysis revealed that younger age at surgery and needing no more than one continence pad at 1 year both predicted UC recovery beyond 1 year. Specifically, each year older age at the time of surgery was associated with a 23% lower chance of UC recovery within a further 2 years after surgery, while needing two or more pads versus one was associated with an 85% lower odds for UC recovery.

However, among the patients who recovered UC within 1 year of RP, factors predictive of recovery were membranous urethral length and prostatic apex shape.

"Factors that relate to the prostate or membranous urethra might only affect recovery of UC within 1 or 2 years after RP, whereas factors related to the natural course of urinary function, such as age or severity of incontinence at 1 year after surgery, seem to be more strongly related to the recovery of UC later than 1 or 2 years after surgery," remarks the team.

Considering these different sets of factors might help physicians in their counseling of patients suffering from persistent incontinence, especially those who are incontinent beyond 1 year after surgery, say Lee and colleagues.

In addition, it may help physicians to decide whether immediate and definitive treatment is required or whether UC will recover spontaneously with further observation, they conclude.

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