Postprostatectomy urinary function assessment tool refined

Researchers have presented a proposed stratification of the urinary incontinence domain of the Expanded Prostate Cancer Index Composite (EPIC-UIN).

The team suggests cutoffs of "mild," "moderate," and "severe" incontinence, at scores of 70-100, 50-69, and 0-49, respectively.

"This 3-tiered system will aid physicians and patients in interpreting preoperative and postoperative urinary function," say Jonathan Ellison (University of Michigan, Ann Arbor, USA) and colleagues.

The EPIC questionnaire has been developed specifically to assess the functional outcomes in prostate cancer survivors but one limitation of the questionnaire is that categoric thresholds have not yet been developed for the UIN domain.

To create thresholds, the researchers reviewed EPIC questionnaires that were administered to 446 patients who underwent either robotic-assisted or radical retropubic prostatectomy. The patients completed the questionnaire preoperatively and again at 3, 6, 9, and 12 months after surgery, and yearly thereafter for 5 years.

At the same timepoints, they also obtained patient scores for the Incontinence System Index (ISI) questionnaire, a health-related quality of life instrument used to measure incontinence and response to anti-incontinence interventions. Cutpoints were chosen for the EPIC-UIN that correlated with the ISI thresholds and analysis performed to test this correlation.

As reported in Urology, the range of ISI scores preoperatively and at 3, 6, 9, and 12 months was "mild" (0-6), "moderate" (7-16), and severe (≥17) in 58.9%, 28.9%, and 11.3% of patients, respectively.

An EPIC-UIN score of 0-49, 50-69, and 70-100 was chosen to correlate with the ISI score of "severe," "moderate," and "mild," and the agreement of the proposed EPIC-UIN thresholds to established ISI thresholds was 74.1%.

Categorizing the EPIC-UIN scores in this way will help to guide physicians in communicating such scores to patients and making recommendations regarding future treatment, the researchers say.

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