Urinary incontinence risk tool helps guide radical prostatectomy patients

Researchers have developed a multivariable risk classification tool for estimating patients' risk for urinary incontinence (UI) after undergoing radical prostatectomy (RP) for prostate cancer.

"This tool may significantly help in improving patient counseling as well as in optimizing patients' expectations about their functional status after surgery," say Firas Abdollah (Vita Salute San Raffaele University, Milan, Italy) and colleagues.

In a study of 1311 men, those who were impotent before RP, elderly, and/or overweight were at the greatest risk for postoperative UI, they report in BJU International.

Patients who had undergone nerve-sparing RP for prostate cancer provided prospective questionnaire data every 3 months for the first year after surgery and every 6 months thereafter. At each assessment, patients completed the International Consultation on Incontinence Modular Questionnaire - short form (ICIQ-SF) and the International Index of Erectile Function - Erectile Function domain (IIEF-EF) questionnaire.

To develop the tool, the team used regression tree analysis to stratify the patients into four risk categories, according to their preoperative characteristics and their postoperative UI risk.

The risk groups comprised a high risk (IIEF-EF=1-10), an intermediate risk (IIEF-EF >10, age ≥65 years), a low risk (IIEF-EF >10, age <65 years, and body mass index [BMI] ≥25 kg/m2), and a very low risk (IIEF-EF >10, age <65 years, BMI <25 kg/m2) group.

The researchers report that across the entire cohort, the 3-, 6-, and 12-month postoperative UI rates were 44%, 26%, and 12%.

In the high, intermediate, low, and very low risk groups, the respective UI rates 3 months after surgery were 48%, 45%, 43%, and 37%. After 6 months, these rates decreased to 34%, 29%, 23%, and 19%, and after 12 months they had further decreased to 15%, 14%, 13%, and 7%.

When patients were stratified by surgery type, the correlation between UI risk classification and actual observed UI rates held true for both retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALP).

The team says their study provides "an accurate UI risk classification tool that can be applied to patients treated with traditional RRP as well as to patients with RALP."

"This tool might be useful to accurately inform each patient about his postoperative UI risk, thus improving the quality of patient counselling," suggest the authors.

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