EAU 2012 - The key role of time in predicting post-radical prostatectomy urinary continence recovery rate: Conditional survival analysis - Session Highlights


PARIS, FRANCE (UroToday.com) - In patients treated with radical prostatectomy (RP), the probability of urinary continence (UC) recovery is often higher during the initial months after surgery.

However, for those men who are not yet recovering UC at a certain time point, the probability of UC recovery at long term changes significantly according to the time between surgery and patient assessment. For example, patients still incontinent at 3 and 6 months follow-up might have a different UC recovery rate at longer follow-up. This effect, otherwise known as conditional survival, has not been assessed yet. This group from Italy set out to evaluate the long-term probability of UC according to the time between surgery and patient evaluation.

Their study included 1371 patients treated with RP between January 2000 and June 2011 at a single tertiary referral center. All patients had complete clinical and follow-up data. Kaplan-Meier curves assessed the time to UC recovery (defined as use of no pads). Cumulative survival estimates were used to generate conditional survival rates assessed with a six-month interval. Cox regression analyses were performed to predict UC continence recovery, after stratification according to the post-operative period, and adjusting to body mass index (BMI), nerve-sparing status, and tumor characteristics.

Mean patient age was 62.6 years (median: 62.6, range: 40.0-85.0). Mean BMI was 26.0 kg/m2 (median: 25.6, range: 17.3-41.9). Rates of UC recovery were 73.8, 92.5 and 96.1% at 6-month, 2-year and 3-year follow-up, respectively. However, in patients that were still incontinent at a certain time point after surgery, the probability of UC recovery in the following 6 months significantly decreased as the time from surgery increased, being 53.3, 31.8, 9.9, 15.8, 16.1 and 8.0% for patients still incontinent at , 6, 12, 18, 24, 32, and 38 months after surgery. This decrement trend in the 6-month continence-recovery rate holds true, when patients were stratified into: age ≤62.6 years (75.8% vs. 25.0%), age >62.6 years (71.8% vs. 0%), BMI ≥25.6 kg/m2 (71.6% vs. 11.1%), and BMI <25.6 kg/m2 (76.5% vs. 0%; p<0.001). These results were confirmed at multivariable analyses (p=0.001).

In incontinent patients, the period elapsed from RP represents an important predictor of the subsequent rate of continent-recovery. The highest rate of continence-recovery is limited to the first 18 months after RP, regardless of age, BMI, and/or patient characteristics.


Presented by Abdollah F, Passoni N, Di Trapani D, Tutolo M, Ferrari M, Di Trapani E, Gandaglia G, Fossati N, Saccà A, Salonia A, Rigatti P, and Colombo R at the 27th Annual European Association of Urology (EAU) Congress - February 24 - 28, 2012 - Le Palais des Congrès de Paris, Paris, France

Urological Research Institute, University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy

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