Age at surgery, educational level and long-term urinary incontinence after radical prostatectomy

Study Type – Harm (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Several factors, including age, body mass index (BMI), prostate size and previous transurethral resection of the prostate, have been suggested to play a part in determining the risk of urinary incontinence after radical prostatectomy. Results relating to the importance of each factor have been conflicting, so we need more data to be able to identify the relevant factors. In this consecutive series, with information from 1179 patients who had undergone radical prostatectomy, age at the time of surgery, educational level, respiratory disease and salvage radiation therapy predicted the occurrence of long‐term urinary incontinence. Increasing age predicted the risk in an exponential manner, and the data indicate a correlation across all educational levels. There was no certain association between previous transurethral resection of the prostate, increased BMI or prostate size and urinary incontinence.

OBJECTIVE

? To identify predictors for long‐term urinary leakage after radical prostatectomy.

PATIENTS AND METHODS

? A consecutive series of 1411 patients who underwent radical prostatectomy (open surgery or robot‐assisted laparoscopic surgery) at Karolinska University Hospital between 2002 and 2006 were invited to complete a study‐specific questionnaire. ? Urinary leakage was defined as use of two or more pads per day.

RESULTS

? Questionnaires were received from 1288 (91%) patients with a median follow‐up of 2.2 years. Age at surgery predicts in an exponential manner long‐term urinary incontinence at follow‐up with an estimated relative increase of 6% per year. ? Among the oldest patients, 19% had urinary incontinence compared with 6% in the youngest age group, translating to a prevalence ratio of 2.4 (95% confidence interval [CI], 1.5–8.1). ? Low educational level, as compared with high, yielded an increased age‐adjusted prevalence ratio of 2.5 (95% CI, 1.7–3.9). ? Patients who had undergone salvage radiation therapy had an increased prevalence of urinary incontinence (2.5; 95% CI, 1.6–3.8), as did those with respiratory disease (2.4; 95% CI, 1.3–4.4). ? Body mass index, prostate weight, presence of diabetes or previous transurethral resection did not appear to influence the prevalence of urinary incontinence.

CONCLUSIONS

? In this series, a patient’s age at radical prostatectomy influenced, in an exponential manner, his risk of long‐term urinary incontinence. ? Other predictors are low educational level, salvage radiation therapy and respiratory disease. ? Intervention studies are needed to understand if these data are relevant to the prevalence of urinary leakage if a radical prostatectomy is postponed in an active monitoring programme.