title: Urinary Incontinence Following Prostate Brachytherapy.
abstract: OBJECTIVE
  To define the incidence, time course, and risk factors associated with the development of urinary incontinence (UI) following prostate brachytherapy.
  
  
  METHODS
  A total of 2461 men were identified who underwent permanent interstitial prostate brachytherapy with or without external beam radiation therapy. We examined the relationship between clinical- and treatment-related variables with the onset of UI, defined as leakage requiring pad usage, and further classified as stress (SUI) or urge (UUI) predominant, using univariate and Cox proportional hazards regression models. The changes in International Prostate Symptom Score and quality of life domains were assessed from baseline to last follow, and examined by UI status.
  
  
  RESULTS
  Patients were followed for a median of 6.4 years (interquartile range 4.1-9.3). UI was reported in 108 individuals (4.4%), at a median of 1.8 years (interquartile range 5 months-4.4 years): 30 with SUI and 78 with UUI. Seventy-two men (66.7%) reported using 1, 24 (22.2%) using 2, and 12 (11%) using ≥3 pads per day. On multivariate analysis, post-implantation transurethral resection of the prostate, urinary retention, external beam radiation therapy, and higher pretreatment International Prostate Symptom Score were significantly associated with the development of SUI, although transurethral resection of the prostate was the only significant risk factor associated with SUI. Men experiencing UI reported greater declines in urinary quality of life; however, no significant difference was observed between SUI and UUI.
  
  
  CONCLUSIONS
  UI occurred in 4.4% of patients following prostate brachytherapy and is more commonly urge-predominant in character. Distinct risk factors exist for the development of UUI vs SUI. Urinary leakage requiring pad usage was associated with declines in urinary QOL.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Leapman
authors.affiliation: Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
authors.affiliation: Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mock
authors.affiliation: Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stock
authors.affiliation: Smith Institute for Urology Northwell Health System, Lake Success, NY. Electronic address: shall12@northwell.edu.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hall
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D012307:Risk Factors; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology*