Population based study of long-term rates of surgery for urinary incontinence after radical prostatectomy for prostate cancer.
OBJECTIVE
Urinary incontinence can be a significant complication of radical prostatectomy. It can be treated with post-prostatectomy surgical procedures. The long-term rate of patients who undergo these surgeries, including artificial urinary sphincter or urethral sling insertion, is not well described. We examined the long-term rate of post-prostatectomy incontinence surgery and factors influencing it.


METHODS
We performed a population based study of 25,346 men who underwent radical prostatectomy for prostate cancer in Ontario, Canada between 1993 and 2006. We used hospital and cancer registry administrative data to identify patients from this cohort who were later treated with surgery for urinary incontinence.


RESULTS
Of the 25,346 patients 703 (2.8%) underwent artificial urinary sphincter insertion and 282 (1.1%) underwent urethral sling placement a median of 2.9 years after prostatectomy. The probability of an artificial urinary sphincter/sling procedure increased with time from prostatectomy. Cumulative 5, 10 and 15-year Kaplan-Meier rates of an artificial urinary sphincter/sling procedure were 2.6% (95% CI 2.4-2.8), 3.8% (95% CI 3.6-4.1) and 4.8% (95% CI 4.4-5.3), respectively. Factors predicting surgery for incontinence were patient age at radical prostatectomy (HR 1.24 per decade, 95% CI 1.11-1.38, p = 0.0002), radiotherapy after surgery (HR 1.61, 95% CI 1.36-1.90, p <0.0001) and surgeon volume (49 or greater prostatectomies per year) (HR 0.59, 95% CI 0.46-0.77, p <0.0001).


CONCLUSIONS
Of patients who undergo radical prostatectomy 5% are expected to be treated with surgery for urinary incontinence during a 15-year period. Increasing patient age, radiation treatment and low surgeon volume are associated with significantly higher risk.
Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada. Robert.nam@utoronto.ca
Robert K
RK
Nam
Sender
S
Herschorn
D Andrew
DA
Loblaw
Ying
Y
Liu
Laurence H
LH
Klotz
Lesley K
LK
Carr
Ronald T
RT
Kodama
Aleksandra
A
Stanimirovic
Vasundara
V
Venkateswaran
Refik
R
Saskin
Calvin H L
CH
Law
David R
DR
Urbach
Steven A
SA
Narod
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D053825:Suburethral Slings; D014549:Urinary Incontinence / Q000453:epidemiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial