Prospective assessment of patient reported urinary continence after radical prostatectomy.
OBJECTIVE
Reported urinary continence rates after radical prostatectomy vary. Although modifications of radical prostatectomy meant to improve outcome, such as nerve sparing or bladder neck preservation, are in widespread use, to our knowledge evidence to support these practices based on patient report is scant. We evaluated the potential effects of nerve sparing and bladder neck preservation on urinary continence after radical prostatectomy, and assessed the impact of various urinary continence definitions on the observed outcome.


METHODS
We prospectively evaluated a cohort of men with prostate cancer who elected surgery with and without nerve sparing, and bladder neck preservation as primary therapy. A total of 482 men completed a brief urinary continence questionnaire preoperatively and postoperatively at a median followup of 18 months. Urinary continence was followed prospectively using the questionnaire and patient reported urinary continence recovery was based on 3 definitions of continence.


RESULTS
Median time to continence recovery based on patient reporting was significantly shorter in the nerve sparing than in the nonnerve sparing group when continence was defined as no urinary leakage (5.3 versus 10.9 months, p <0.01). A multivariate model controlling for baseline factors revealed that significant predictors of continence outcome were preoperative continence, patient age, nerve sparing and the interaction of nerve sparing with age (p <0.05). The definition of urinary continence also affected outcome.


CONCLUSIONS
The nerve sparing technique of radical prostatectomy was associated with improved recovery of urinary continence in an age dependent manner, whereas bladder neck preservation was not beneficial. Patient age and the sensitivity of the incontinence definitions, as reflected by the associated variable rates of preoperative baseline incontinence, are significant contexts for interpreting urinary function data after radical prostatectomy. These factors may partially explain the variation in continence rates in the literature.
Wei
J T
JT
Robert Wood Johnson Clinical Scholars Program, Urology Section and Comprehensive Cancer Center, University of Michigan, Ann Arbor, USA.
Dunn
R L
RL
Marcovich
R
R
Montie
J E
JE
Sanda
M G
MG
D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology*; D014554:Urination / Q000502:physiology*