title: A novel tool to assess the risk of urinary incontinence after nerve-sparing radical prostatectomy.
abstract: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Urinary incontinence is one of the most important morbidities after radical prostatectomy that has detrimental effect on the postoperative quality of life. The present study provides an accurate and dynamic multivariable risk stratification tool that predicts the postoperative urinary incontinence risk after radical prostatectomy based on patient-related as well as surgeon-related variables.
  
  
  OBJECTIVE
  To develop a multivariable risk classification tool to estimate postoperative urinary incontinence (UI) risk as UI represents one of the most disabling surgical sequelae after radical prostatectomy (RP).
  
  
  METHODS
  We evaluated 1311 patients treated with nerve-sparing RP between 2006 and 2010 at our institution. Regression tree analysis was used to stratify patients according to their postoperative UI risk. Kaplan-Meier curve estimates were used to assess the UI rate in the novel UI-risk groups. The discrimination of the novel tool was measured with the area under the curve method.
  
  
  RESULTS
  At 3, 6 and 12 months, the UI rates were 44%, 26% and 12%, respectively. Regression tree analysis stratified patients into high risk (International Index of Erectile Function - Erectile Function domain [IIEF-EF] = 1-10), intermediate risk (IIEF-EF > 10 and age ≥ 65 years), low risk (IIEF-EF > 10, age < 65 years and body mass index [BMI] ≥ 25 kg/m(2) ) and very low risk (IIEF-EF > 10, age < 65 years and BMI < 25 kg/m(2) ) groups. The 3-month UI rates in these groups were 37%, 43%, 45% and 48%, respectively. The 6-month UI rates were 19%, 23%, 29% and 34%, respectively. The 12-month UI rates were 7%, 13%, 14% and 15%, respectively (log-rank P < 0.001). The area under the curve was 71%, 70% and 68% at 3, 6 and 12 months, respectively.
  
  
  CONCLUSIONS
  We developed the first risk classification tool that predicts patients at high risk of UI after RP. These consisted mainly of individuals who were impotent before RP, elderly and/or overweight. This tool can be used for patient counselling.
authors: Department of Urology, Vita Salute San Raffaele University, Milan, Italy. firas.abdollah@gmail.com
authors: Firas
authors: F
authors: Abdollah
authors: Maxine
authors: M
authors: Sun
authors: Nazareno
authors: N
authors: Suardi
authors: Andrea
authors: A
authors: Gallina
authors: Manuela
authors: M
authors: Tutolo
authors: Niccolò
authors: N
authors: Passoni
authors: Marco
authors: M
authors: Bianchi
authors: Andrea
authors: A
authors: Salonia
authors: Renzo
authors: R
authors: Colombo
authors: Patrizio
authors: P
authors: Rigatti
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Francesco
authors: F
authors: Montorsi
authors: Alberto
authors: A
authors: Briganti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D018570:Risk Assessment; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology