To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI).
We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum's de-identified Clinformatics® Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis.
Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery.
The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient's comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.
Prostate cancer and prostatic diseases. 2022 Jun 21 [Epub ahead of print]
Francesco Del Giudice, Jianlin Huang, Shufeng Li, Simon Sorensen, Ekene Enemchukwu, Martina Maggi, Stefano Salciccia, Matteo Ferro, Felice Crocetto, Savio Domenico Pandolfo, Riccardo Autorino, Wojciech Krajewski, Simone Crivellaro, Giovanni E Cacciamani, Eugenio Bologna, Vincenzo Asero, Carlo Scornajenghi, Marco Moschini, David D'Andrea, David R Brown, Benjamin I Chung
Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy. ., Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Urology, Aarhus University, Aarhus, Denmark., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Division of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy., Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA., Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland., University of Illinois Hospital & Health Sciences System, Chicago, IL, USA., USC Institute of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, San Raffaele Hospital, IRCCS Milan, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria., Geisel School of Medicine, Dartmouth, NH, USA.