Urinary incontinence and use of incontinence surgery after radical prostatectomy: a national study using patient-reported outcomes.

To investigate whether patient-reported urinary incontinence and bother scores after radical prostatectomy result in subsequent intervention with incontinence surgery.

Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative data were used to identify men who had undergone a radical prostatectomy and those who subsequently underwent a urinary incontinence procedure. The National Prostate Cancer Audit database was used to identify men who had also completed a post-treatment survey. These surveys included the Expanded Prostate Cancer Composite Index (EPIC-26). The frequency of subsequent incontinence procedures, within 6 months of the survey, was explored according to EPIC-26 urinary incontinence scores. The relationship between "good" (≥75) or "bad" (≤25) EPIC-26 urinary incontinence scores and perceptions of urinary bother was also explored (responses ranging from 'no problem' to 'big problem' with respect to their urinary function).

We identified 11,290 men who had undergone a radical prostatectomy. The 3-year cumulative incidence of incontinence surgery was 2.5%. After exclusions, we identified 5,165 men who had also completed a post-treatment survey after a median time of 19 months (response rate 74%). 481 men (9.3%) reported a "bad" urinary incontinence score and 207 men (4.0%) also reported that they had a big problem with their urinary function. 47 men went on to have incontinence surgery within 6 months of survey completion (0.9%), of whom 93.6% had a "bad" urinary incontinence score. Of the 71 men with the worst urinary incontinence score (zero), only 11 men (15.5%) subsequently had incontinence surgery.

In England, there is a significant number of men living with severe, bothersome urinary incontinence following radical prostatectomy, and an unmet clinical need for incontinence surgery. The systematic collection of patient-reported outcomes could be used to identify men who may benefit from incontinence surgery.

BJU international. 2021 Nov 30 [Epub ahead of print]

Matthew G Parry, Ted A Skolarus, Julie Nossiter, Arunan Sujenthiran, Melanie Morris, Thomas E Cowling, Brendan Berry, Ajay Aggarwal, Heather Payne, Paul Cathcart, Noel W Clarke, Jan van der Meulen

Department of Health Services Research & Policy, LHSTM, USA., Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA., Clinical Effectiveness Unit, Royal College of Surgeons of England, USA., Department of Radiotherapy, NHS Foundation Trust, Guy's & St Thomas, UK., Department of Oncology, University College London Hospitals, London, UK., Department of Urology, NHS Foundation Trust, Guy's & St Thomas, UK., Department of Urology, Salford Royal NHS Foundation Trusts, The Christie &, UK.

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