Urololgy: Quality of Life Not Hampered by Incontinence after Prostatectomy

The study results may help provide patients with more realistic expectations and decrease potential regret after surgery

Despite patient concerns about incontinence after robot-assisted radical prostatectomy (RARP), there is little interference with quality of life, according to the results of a study published recently in The Journal of Urology.

Health-related quality of life is an important factor when deciding on organ-confined prostate cancer treatment, and urinary incontinence is a predictor of patient post-treatment dissatisfaction. Preoperative counseling is an important part of preparing patients for what to expect after radical prostatectomy. And although incontinence is common, note the authors of the current study, the current literature defines it poorly. Thus, the authors sought to characterize incontinence after RARP to help improve preoperative counseling of patients.

The researchers performed a cross-sectional survey of the first 600 patients with prostate cancer who underwent RARP at the Mayo Clinic in Phoenix, AZ between March 2004 and September 2007. Patients completed the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life and Urinary Incontinence Short Form, which the researchers evaluated to determine post-procedure patient incontinence and quality of life. The response rate was 68 percent (408 of the 600 patients), with response times ranging from two and one-half months to four years.

Of the 315 patients who responded at least one year after surgery, 26 percent reported perfect continence, 83 percent were continent using a definition of zero to one pad per day, and 78 percent of men were continent using a definition of no pads per day. Older patients tended to have higher incontinence rates. Twenty-four percent of patients older than 70 years reported incontinence compared to 20 percent of men ages 60 to 70 years and 10 percent for men younger than 60 years. Patients leaked most often during exercise and when coughing or sneezing, and were most affected during physical activities and work or activity outside the home. Ten percent of men who reported incontinence were significantly affected during physical activities. Fifty percent of incontinent patients reported some amount of depression or anxiety about leakage. The condition did not significantly affect patients' social lives, although approximately 30 percent of incontinent patients reported some effect on partner relationships and 40 percent reported effects on their sex lives.

The authors conclude that the current study results can be used “to help counsel patients with detailed outcomes after RARP. This may help provide them with more realistic expectations and decrease potential regret after surgery.”

Source: Martin AD, Nakamura LY, Nunez RN, et al. 2011. Incontinence after radical prostatectomy: a patient centered analysis and implications for preoperative counseling. The Journal of Urology 186:204-208.