title: How should continence and incontinence after radical prostatectomy be evaluated? A prospective study of patient ratings and changes with time.
abstract: OBJECTIVE
  We examined prevalence rates, and changes in continence and incontinence before and after radical prostatectomy for prostate cancer by comparing different definitions. We also studied the descriptive validity of the grading system of Ellison et al for post-prostatectomy incontinence and baseline predictors of post-prostatectomy incontinence at 12 months.
  
  
  METHODS
  This national prospective study included 844 patients treated with radical prostatectomy between 2005 and 2009. Adverse effects, including urinary dysfunction and bother, were reported by 735 patients (88%) using the EPIC-50 and UCLA-PCI validated questionnaires at baseline and 12-month followup. Linear regression analysis was done to examine baseline predictors and the degree of post-prostatectomy incontinence at followup.
  
  
  RESULTS
  At 12 months after radical prostatectomy 74% of patients reported post-prostatectomy incontinence, of whom 40% used pads daily, 34% reported occasional dribbling without pads and 26% had total urinary control. When defined as total incontinence/no urinary control, severe post-prostatectomy incontinence was reported by 3% of the men but 25% had severe post-prostatectomy incontinence according to the stratification of Ellison et al. Of patients with preoperative incontinence 14% improved postoperatively. Predictors of post-prostatectomy incontinence were age 65 years or greater, not working, sexual dysfunction and incontinence preoperatively. The latter 2 remained the strongest predictors on multivariate analysis. Prostate cancer related variables were not associated with post-prostatectomy incontinence.
  
  
  CONCLUSIONS
  The prevalence of post-prostatectomy incontinence varied considerably according to the definition applied. In our opinion incontinence may be reported as any leakage and not only as pad use with grading done on a symptom scale. Preoperative sexual dysfunction and urinary incontinence were the strongest predictors of post-prostatectomy incontinence at 12-month followup.
authors.affiliation: University of Oslo, Oslo, Norway. Electronic address: hveiby@ous-hf.no.
authors.forename: Henriette Veiby
authors.initials: HV
authors.lastname: Holm
authors.affiliation: Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.affiliation: Department of Urology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Hans
authors.initials: H
authors.lastname: Hedlund
authors.affiliation: Department of Urology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schultz
authors.affiliation: Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011184:Postoperative Period; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D012720:Severity of Illness Index; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D014554:Urination / Q000502:physiology*
keywords: erectile dysfunction; prostate; prostatectomy; quality of life; urinary incontinence