Risk Factors for Urinary Incontinence after Radical Prostatectomy

Abstract

No AccessJournal of UrologyClinical Urology: Original Article1 Nov 1996Risk Factors for Urinary Incontinence after Radical Prostatectomy James A. Eastham, Michael W. Kattan, Eamonn Rogers, Jeremy R. Goad, Makoto Ohori, Timothy B. Boone, and Peter T. Scardino James A. EasthamJames A. Eastham , Michael W. KattanMichael W. Kattan , Eamonn RogersEamonn Rogers , Jeremy R. GoadJeremy R. Goad , Makoto OhoriMakoto Ohori , Timothy B. BooneTimothy B. Boone , and Peter T. ScardinoPeter T. Scardino View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65488-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We identified risk factors associated with urinary incontinence after radical retropubic prostatectomy. Materials and Methods: The time from operation until urinary continence was achieved was determined by chart review and questionnaire in 581 patients who were continent before undergoing radical retropubic prostatectomy between 1983 and 1994. Using univariate and multivariate analyses of data gathered prospectively, we examined risk factors associated with incontinence in these patients. Results: The actuarial rate of urinary continence at 24 months was 91 percent for the entire patient populations and 95 percent for those treated after 1990. Many factors were associated with the risk of incontinence in univariate Cox proportional hazards regression analysis (patient age and weight, degree of obstructive voiding symptoms, prior transurethral resection of the prostate, clinical stage, intraoperative blood loss, resection of neurovascular bundles, postoperative anastomotic stricture and technique of vesicourethral anastomosis). However, in a multivariate analysis the factors that were independently associated with increased chance of regaining continence were decreasing age, a modification in the technique of anastomosis (introduced in 1990), preservation of both neurovascular bundles and absence of an anastomotic stricture. With introduction of the new surgical technique in 1990 the median time to continence decreased from 5.6 to 1.5 months and the rate of continence at 24 months increased from 82 to 95 percent. Conclusions: While the risk of urinary incontinence after radical prostatectomy is related to the uncontrollable factor of patient age, it is also sensitive to the surgical technique used. References 1 : Impact of anatomical radical prostatectomy on urinary continence. J. Urol.1991; 145: 512. Link, Google Scholar 2 : Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J. Urol.1993; 150: 905. Link, Google Scholar 3 Stapleton, A. M. F. and Scardino, P. T.: Nerve-sparing radical retropubic prostatectomy. In: Operative Urology. Edited by R. J. Krane, J. Fitzpatrick and M. B. Siroky. New York: Churchill-Livingstone, in press. Google Scholar 4 : Continence following nerve-sparing radical prostatectomy. J. Urol.1989; 142: 1227. Link, Google Scholar 5 : Early continence after radical prostatectomy. J. Urol.1992; 148: 92. Link, Google Scholar 6 : Radical retropubic prostatectomy: morbidity and quality of life. experience with 620 consecutive cases. J. Urol., part 21992; 147: 883. Abstract, Google Scholar 7 : Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J. Urol., part 21994; 152: 1850. Abstract, Google Scholar 8 : Surgical management of prostate cancer. Cancer1995; 75: 1903. Google Scholar 9 : Radical retropubic prostatectomy in the treatment of prostatic carcinoma. J. Urol.1970; 103: 641. Link, Google Scholar 10 : Radical retropubic prostatectomy for cancer: a 20-year experience. J. Urol.1977; 117: 330. Google Scholar 11 : Radical retropubic prostatectomy after transurethral prostatic resection. J. Urol.1980; 124: 495. Link, Google Scholar 12 : Incontinence and vesical neck strictures following radical retropubic prostatectomy. Urology1995; 45: 1000. Google Scholar 13 : Urodynamic evaluation of incontinence in patients undergoing modified Campbell radical retropubic prostatectomy: a prospective study. J. Urol.1984; 132: 708. Link, Google Scholar 14 : The morbidity of radical prostatectomy for multifocal stage I prostatic adenocarcinoma. J. Urol.1977; 117: 83. Link, Google Scholar 15 : Morbidity of radical perineal prostatectomy following transurethral resection of prostate. J. Urol.1984; 132: 55. Abstract, Google Scholar 16 : The TNM classification of prostate cancer. Prostate1992; 4: 129. Google Scholar 17 : Radical retropubic prostatectomy. In: . Philadelphia: W. B. Saunders Co1992: 2865. chapt. 78. Google Scholar 18 : Radical retropubic prostatectomy: limited benefit of autologous blood donation. J. Urol.1995; 154: 2103. Link, Google Scholar 19 : Modifications in the technique of radical retropubic prostatectomy to minimize blood loss. Urol. Clin. N. Amer.1994; 20: 65. Google Scholar 20