Patient- and Tumour-related Prognostic Factors for Urinary Incontinence After Radical Prostatectomy for Nonmetastatic Prostate Cancer: A Systematic Review and Meta-analysis.

While urinary incontinence (UI) commonly occurs after radical prostatectomy (RP), it is unclear what factors increase the risk of UI development.

To perform a systematic review of patient- and tumour-related prognostic factors for post-RP UI.

The primary outcome was UI within 3 mo after RP. Secondary outcomes included UI at 3-12 mo and ≥12 mo after RP.

Databases including Medline, EMBASE, and CENTRAL were searched between January 1990 and May 2020. All studies reporting patient- and tumour-related prognostic factors in univariable or multivariable analyses were included. Surgical factors were excluded. Risk of bias (RoB) and confounding assessments were performed using the Quality In Prognosis Studies (QUIPS) tool. Random-effects meta-analyses were performed for all prognostic factor, where possible.

A total of 119 studies (5 randomised controlled trials, 24 prospective, 88 retrospective, and 2 case-control studies) with 131 379 patients were included. RoB was high for study participation and confounding; moderate to high for statistical analysis, study attrition, and prognostic factor measurement; and low for outcome measurements. Significant prognostic factors for postoperative UI within 3 mo after RP were age (odds ratio [OR] per yearly increase 1.04, 95% confidence interval [CI] 1.03-1.05), membranous urethral length (MUL; OR per 1-mm increase 0.81, 95% CI 0.74-0.88), prostate volume (PV; OR per 1-ml increase 1.005, 95% CI 1.000-1.011), and Charlson comorbidity index (CCI; OR 1.28, 95% CI 1.09-1.50).

Increasing age, shorter MUL, greater PV, and higher CCI are independent prognostic factors for UI within 3 mo after RP, with all except CCI remaining prognostic at 3-12 mo.

We reviewed the literature to identify patient and disease factors associated with urinary incontinence after surgery for prostate cancer. We found increasing age, larger prostate volume, shorter length of a section of the urethra (membranous urethra), and lower fitness were associated with worse urinary incontinence for the first 3 mo after surgery, with all except lower fitness remaining predictive at 3-12 mo.

European urology focus. 2021 May 06 [Epub ahead of print]

Michael Lardas, Nikos Grivas, Thomas P A Debray, Fabio Zattoni, Christopher Berridge, Marcus Cumberbatch, Thomas Van den Broeck, Erik Briers, Maria De Santis, Andrea Farolfi, Nicola Fossati, Giorgio Gandaglia, Silke Gillessen, Shane O'Hanlon, Ann Henry, Matthew Liew, Malcolm Mason, Lisa Moris, Daniela Oprea-Lager, Guillaume Ploussard, Olivier Rouviere, Ivo G Schoots, Theodorus van der Kwast, Henk van der Poel, Thomas Wiegel, Peter-Paul Willemse, Cathy Y Yuan, Jeremy P Grummet, Derya Tilki, Roderick C N van den Bergh, Thomas B Lam, Philip Cornford, Nicolas Mottet

Department of Urology, Metropolitan General Hospital, Athens, Greece. Electronic address: ., Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece., Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy., Worcestershire Acute Hospitals NHS Trust, Redditch, UK., Academic Urology Unit, University of Sheffield, Sheffield, UK., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Patient Advocate, Hasselt, Belgium., Department of Urology, Charité Universitätsmedizin Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria., Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy., Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland., Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland., Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK., Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK., Division of Cancer & Genetics, Cardiff University School of Medicine, Velindre Cancer Centre, Cardiff, UK., Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands., La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., Department of Oncological Urology, University Medical Center, Utrecht Cancer Center, Utrecht, The Netherlands., Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada., Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia., Martini-Klinik Prostate Cancer Center, and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Antonius Hospital, Utrecht, The Netherlands., Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK., Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK., Department of Urology, University Hospital, St. Etienne, France.

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