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Keywords:

  • prostatectomy/adverse effects;
  • risk assessment;
  • survival analysis;
  • urinary incontinence/aetiology;
  • treatment outcome

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).

Patients and 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/m2) and very low risk (IIEF-EF > 10, age < 65 years and BMI < 25 kg/m2) 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.