title: Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis.
abstract: OBJECTIVE
  Urinary incontinence is a frequent complication of radical prostatectomy with a detrimental impact on quality of life. We identified predictors and trends in the use of procedures for post-prostatectomy incontinence.
  
  
  METHODS
  Using SEER (Surveillance, Epidemiology and End Results) cancer registry data linked with Medicare claims, we identified men 66 years old or older who were treated with radical prostatectomy in 2000 to 2007. The primary outcome was performance of an incontinence procedure. Demographic and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis.
  
  
  RESULTS
  Of 16,348 men treated with radical prostatectomy 1,057 (6%) had undergone at least 1 incontinence procedure by a median of 20 months after the procedure, including 61% who underwent the first incontinence procedure within 2 years of prostatectomy. Older age and residence in the South were associated with greater probability of an incontinence procedure. Black men and those living in nonmetropolitan areas were less likely than their peers to undergo an incontinence procedure. Of men treated with any incontinence procedure 15% underwent more than 1 type. Of those treated with bulking agents 39% also received a urethral sling or artificial urinary sphincter and 13% who received a sling also had an artificial urinary sphincter. In 34% of the men who underwent any incontinence surgery artificial urinary sphincter placement was the only procedure performed.
  
  
  CONCLUSIONS
  In this population based cohort of older men with prostate cancer only 6% underwent an incontinence procedure after prostatectomy. This low rate may reflect the underuse of potentially beneficial procedures.
authors.affiliation: Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, New York 10065, USA. kimp@mskcc.org
authors.forename: Philip H
authors.initials: PH
authors.lastname: Kim
authors.forename: Laura C
authors.initials: LC
authors.lastname: Pinheiro
authors.forename: Coral L
authors.initials: CL
authors.lastname: Atoria
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Sandhu
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends*