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Population Based Study of Long-Term Rates of Surgery for Urinary Incontinence After Radical Prostatectomy for Prostate Cancer

2012; Lippincott Williams & Wilkins; Volume: 188; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2012.04.005

1527-3792

Robert K. Nam, Sender Herschorn, D. Andrew Loblaw, Ying Liu, Laurence Klotz, Lesley K. Carr, Ronald Kodama, Aleksandra Stanimirovic, Vasundara Venkateswaran, Refik Saskin, Calvin Law, David R. Urbach, Steven A. Narod,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyAdult Urology1 Aug 2012Population Based Study of Long-Term Rates of Surgery for Urinary Incontinence After Radical Prostatectomy for Prostate Cancer Robert K. Nam, Sender Herschorn, D. Andrew Loblaw, Ying Liu, Laurence H. Klotz, Lesley K. Carr, Ronald T. Kodama, Aleksandra Stanimirovic, Vasundara Venkateswaran, Refik Saskin, Calvin H.L. Law, David R. Urbach, and Steven A. Narod Robert K. NamRobert K. Nam Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Sender HerschornSender Herschorn Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , D. Andrew LoblawD. Andrew Loblaw Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Ying LiuYing Liu Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada , Laurence H. KlotzLaurence H. Klotz Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Lesley K. CarrLesley K. Carr Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Ronald T. KodamaRonald T. Kodama Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Aleksandra StanimirovicAleksandra Stanimirovic Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Vasundara VenkateswaranVasundara Venkateswaran Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada , Refik SaskinRefik Saskin Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada , Calvin H.L. LawCalvin H.L. Law Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada , David R. UrbachDavid R. Urbach Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada , and Steven A. NarodSteven A. Narod Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada View All Author Informationhttps://doi.org/10.1016/j.juro.2012.04.005AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 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. Materials and 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. References 1 : Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med2005; 352: 1977. Google Scholar 2 : Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA2000; 283: 354. Crossref, Medline, Google Scholar 3 : Postprostatectomy incontinence: all about diagnosis and management. Eur Urol2009; 55: 322. Google Scholar 4 : Surgical treatment of stress incontinence in men. Neurourol Urodyn2010; 29: 179. Google Scholar 5 : Current use of artificial urinary sphincters in the United States. J Urol2007; 178: 578. Link, Google Scholar 6 : Variations in morbidity after radical prostatectomy. N Engl J Med2002; 346: 1138. 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Link, Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byDoiron R, Saavedra A, Haines T, Nadeau G, Tu L, Morisset J, Steele S, Valiquette L, Elterman D, Maciejewski C and Rourke K (2019) Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter StudyJournal of Urology, VOL. 202, NO. 5, (1022-1028), Online publication date: 1-Nov-2019.Aliperti L, Patil D, Filson C, Hartsell L, Carney K, Sanda M and Mehta A (2018) Genitourinary Prosthetic Use among Prostate Cancer Survivors Treated with Radical ProstatectomyUrology Practice, VOL. 6, NO. 2, (123-128), Online publication date: 1-Mar-2019.Viers B, VanDyke M, Pagliara T, Shakir N, Scott J and Morey A (2017) Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?Urology Practice, VOL. 5, NO. 6, (458-465), Online publication date: 1-Nov-2018.Radomski S, Ruzhynsky V, Wallis C and Herschorn S (2018) Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term ResultsJournal of Urology, VOL. 200, NO. 5, (1093-1098), Online publication date: 1-Nov-2018.Boone T (2016) How to Decide Whether an Artificial Urinary Sphincter or a Male Sling is Best for Male Stress Urinary IncontinenceJournal of Urology, VOL. 196, NO. 3, (641-642), Online publication date: 1-Sep-2016. Volume 188Issue 2August 2012Page: 502-506 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordssuburethral slingsartificialurinary sphincterprostatectomyurinary incontinenceprostateMetrics Author Information Robert K. Nam Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Sender Herschorn Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada Financial interest and/or other relationship with Allergan, Pfizer, Astellas and Contura. More articles by this author D. Andrew Loblaw Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Ying Liu Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada More articles by this author Laurence H. Klotz Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Lesley K. Carr Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Ronald T. Kodama Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Aleksandra Stanimirovic Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Vasundara Venkateswaran Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada More articles by this author Refik Saskin Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada More articles by this author Calvin H.L. Law Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada More articles by this author David R. Urbach Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada More articles by this author Steven A. Narod Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...