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Background:
Post-radical prostatectomy urinary incontinence (PPI) negatively affects the quality of life of patients. Accurate identification of the problem by physicians is essential for adequate postoperative management. In this study we sought to access whether there is, for urinary incontinence, any discrepancy between medical reports and the...
Contexts in source publication
Context 1
... was more frequent in black subjects, however with no statistical significance. In multivariate analysis, the percentage discrepancy relationship was greater in black subjects (IRR 17.8 95% CI 2.57 to 123.3; p = 0.004) with low schooling (IRR 1.54, 95%CI 1.01 to 2.35; p = 0.043) when compared to Caucasian subjects with high schooling (Table 4). ...Context 2
... was more frequent in black subjects, however with no statistical significance. In multivariate analysis, the percentage discrepancy relationship was greater in black subjects (IRR 17.8 95% CI 2.57 to 123.3; p = 0.004) with low schooling (IRR 1.54, 95%CI 1.01 to 2.35; p = 0.043) when compared to Caucasian subjects with high schooling (Table 4). ...Citations
... Es gibt einige Untersuchungen, die unterstreichen, dass hier ein Kommunikationsproblem zwischen Arzt und Patient bestehen könnte. Zum einen wird ärztlich der Leidensdruck der Betroffenen als weniger problematisch eingeschätzt, als es der Betroffene selbst sieht und zum anderen sprechen es die Betroffenen im Arztkontakt auch weniger als notwendig an [26][27][28] ...
Zusammenfassung
Hintergrund
Die Belastungsinkontinenz des Mannes ist überwiegend iatrogen bedingt. Aktuelle Studien zeigen nicht nur in Deutschland ein Versorgungsdefizit in der operativen Therapie. Ziel ist es, die strukturelle Versorgung der operativen Therapie der männlichen Belastungsinkontinenz in Deutschland detaillierter zu untersuchen.
Material und Methoden
Die Auswertung der strukturellen Versorgung durch Belastungsinkontinenzoperationen des Mannes in Deutschland erfolgt anhand von OPS-Codes der Qualitätsberichte der Krankenhäuser von 2011 bis 2019.
Ergebnisse
Von 2012 bis 2019 zeigt sich ein Rückgang der Inkontinenzoperationen beim Mann von 2191 auf 1445. Die Zahl der Kliniken, die Inkontinenzoperationen durchführen, fiel von 275 auf 244. In der multivariaten Analyse ist eine hohe Zahl ( n ≥ 50) an radikalen Prostatektomien/Jahr (RPE/Jahr) ein unabhängiger Prädiktor für eine High-volume-Klinik (≥ 10 Eingriffe/Jahr: Odds Ratio [OR] 6,4 [2,3–17,6]; p < 0,001). Ein deutlicher Rückgang ist bei Schlingenoperationen (von n = 1091 auf 410; p < 0,001) zu verzeichnen. Hier sank besonders die Fallzahl in Kliniken, die eine hohe Zahl an Schlingen implantierten (≥ 10 Schlingen/Jahr; −69 %; −62,4 ± 15,5 Operationen/Jahr; p = 0,007). Diese haben sich auch in ihrer Anzahl verringert (von n = 34 auf 10; p < 0,001). Dies betraf insbesondere Klinken, die auch eine geringe Zahl an RPE/Jahr aufwiesen (Zahl der Kliniken von 9 auf 0 gefallen [−100 %]).
Schlussfolgerung
Die Versorgungssituation der operativen Therapie der männlichen Belastungsinkontinenz in Deutschland zeigt einen deutlichen Rückgang der Schlingenimplantation, insbesondere in kleinen Kliniken. Auf der einen Seite reflektiert dies die zunehmend differenzierte Indikationsstellung der Schlingenimplantation. Auf der anderen Seite ergibt sich der Verdacht auf eine entstandene Versorgungslücke, da eine Kompensation durch andere operative Verfahren nicht ersichtlich ist.
... Con una divergencia del 42,2% de los casos, en su mayoría de casos los médicos clasificando como continentes a pacientes que reportaban IU en el mismo tiempo. En el análisis multivariante la discrepancia fue mayor en hombres de raza negra con baja escolaridad 17 . En el estudio de Thong et al., en el cual 3.053 pacientes llevados a prostatectomía radical realizaron el cuestionario IIEF durante el seguimiento postoperatorio ambulatorio, por otro lado, los médicos clasificaron la DE en cinco grados, definiendo DE como un puntaje IIEF < 22 puntos o DE grado 3 o más. ...
... The International Continence Society (ICS) has found continence rates ranging from 43 to 98% [14], which are additionally due to differences in data collection and assessment methods, length of follow-up and a divergence between patient and physician perception. Commonly discussed tools to objectively specify and quantify PPI are pad usage, pad weight tests and validated questionnaires, each characterized by a different set of advantages and disadvantages [7,10,11,17,18]. ...
... This, however, comes with the risk of over-reporting severity. Borges et al. recently reported that ICIQ-SF evaluation rated UI as severe for 80.6% of the patients, whilst only 20.6% perceived their UI as severe [18]. ...
Background
A uniform definition of continence is urgently needed to allow the comparison of study results and to estimate patient outcomes after radical prostatectomy (RP). To identify a practical definition that includes both objective and subjective aspects in a tangible way, we assessed different continence definitions and evaluated which best reflects the patients’ subjective perception of continence.
Methods
Our analyses included 718 patients that underwent either robot-assisted radical prostatectomy (RARP) or laparoscopic radical prostatectomy (LRP) in a multicenter randomized patient-blinded trial. Continence was assessed through patient questionnaires prior to and at 3, 6 and 12 months after surgery which included the number of pads used per day, the ICIQ-SF and the question “Do you suffer from incontinence? (yes/no)” to assess subjective continence. We used Krippendorff’s Alpha to calculate the agreement of different continence definitions with the subjective perception.
Results
At 3 months, the “0/safety pad” definition shows the highest agreement by alpha = 0.70 (vs. 0.63 for “0 pads” and 0.37 for “0–1 pad”). At 6 and 12 months “0 pads” is the better match, with alpha values of 0.69 (vs. 0.62 and 0.31) after 6 months and 0.70 (vs. 0.65 and 0.32) after 12 months. The ICIQ-SF score shows good correlation with the subjective continence at 3 months (alpha = − 0.79), the coefficient then decreasing to − 0.69 and − 0.59 at 6 and 12 months.
Conclusion
The best continence definition according to the patients’ perspective changes over time, “0 pads” being the superior criterion in the long-term. We recommend using the 0-pad definition for standardized continence reporting, as it is simple yet as accurate as possible given the inevitably high subjectivity of continence perception.
Trial registration The LAP-01 trial was registered with the U.S. National Library of Medicine clinical trial registry (clinicaltrials.gov), NCT number: NCT03682146, and with the German Clinical Trial registry (Deutsches Register Klinischer Studien), DRKS ID number: DRKS00007138
... 2−7 In recent times, the enhanced comprehension of the functional anatomy of the prostate has resulted in a heightened emphasis on functional outcomes among prostate cancer patients, particularly urinary continence, due to its significant impact on health-related quality of life. 3,[8][9][10][11][12][13] Overall, there is limited data available on the long-term continence outcomes related to the tumor stage. 14 Moreover, conflicting data from large-scale institutional databases exist regarding the impact of extraprostatic vs. organ-confined disease on continence at any given time point. ...
Objectives
Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP).
Method
In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used.
Results
Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85).
Conclusion
In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates.
... Consistent with societal guidelines, patients with mild incontinence will often receive a male sling and patients with severe incontinence will frequently receive an AUS [4]. Currently, for men with moderate stress urinary incontinence (SUI), which accounts for 40-53% of PPI patients, the choice of surgery will be based on patient and surgeon preference as a guideline-directed therapeutic protocol has not yet been established for this group [5,6]. While various complications can result after radical prostatectomy, urinary incontinence can have a severe impact on a patient's quality of life [7]. ...
Simple Summary
Stress urinary incontinence is a common sequela in men after radical prostatectomy for the treatment of prostate cancer. Varying degrees of post-prostatectomy incontinence will present after surgery and surgical treatment may be recommended after one year. The severity of incontinence can range from less than 1 urinary pads per day (PPD) to more than 5 PPD. Treatments for mild incontinence include the male sling while more severe incontinence often requires an artificial urinary sphincter (AUS). Currently, patients with moderate incontinence are treated with either a sling or AUS with variable results. In this paper, we reviewed recent research to demonstrate that AUS should be considered first-line for moderate incontinence. While patients and physicians may be hesitant to proceed with an implantable device, patients achieved better continence rates and overall quality of life when they underwent AUS placement for moderate post-prostatectomy incontinence.
Abstract
Male urinary incontinence is a common complication after radical prostatectomy. The severity of incontinence can be assessed in various ways and helps determine the best surgical intervention to restore continence. While most patients with mild incontinence receive a sling and those with severe incontinence receive an artificial urinary sphincter (AUS), there are no clear guidelines on how to manage patients with moderate post-prostatectomy incontinence (PPI). Our discussion will focus on the current literature, which demonstrates that an AUS should be considered first-line in men with moderate PPI despite perceived concerns over complications and reintervention rates.
... Among these treatment options, robotic-assisted radical prostatectomy is a surgical approach providing optimal oncological outcomes for clinically localized and locally advanced prostate cancer [2][3][4][5][6][7]. However, functional outcomes such as urinary continence represent an important topic, especially considering the impact of concomitant health-related quality of life for prostate cancer patients [2,[8][9][10]. Urinary incontinence following robotic-assisted radical prostatectomy has been previously identified as a significant factor that negatively affects the quality of life for patients and could potentially cause substantial discomfort [2,8,9]. ...
... However, functional outcomes such as urinary continence represent an important topic, especially considering the impact of concomitant health-related quality of life for prostate cancer patients [2,[8][9][10]. Urinary incontinence following robotic-assisted radical prostatectomy has been previously identified as a significant factor that negatively affects the quality of life for patients and could potentially cause substantial discomfort [2,8,9]. Ilie at al. observed a non-negligible association between urinary incontinence and increased mental distress in a contemporary prostate cancer cohort treated with radical prostatectomy [10]. ...
Aim and Objectives: We aimed to test the impact of age on long-term urinary continence (≥12 months) in patients undergoing robotic-assisted radical prostatectomy. Methods and Materials: We relied on an institutional tertiary-care database to identify the patients who underwent robotic-assisted radical prostatectomy between January 2014 and January 2021. Patients were divided into three age groups: age group one (≤60 years), age group two (61–69 years) and age group three (≥70 years). Multivariable logistic regression models tested the differences between the age groups in the analyses addressing long-term urinary continence after robotic-assisted radical prostatectomy. Results: Of the 201 prostate cancer patients treated with robotic-assisted radical prostatectomy, 49 (24%) were assigned to age group one (≤60 years), 93 (46%) to age group two (61–69 years) and 59 (29%) to age group three (≥70 years). The three age groups differed according to long-term urinary continence: 90% vs. 84% vs. 69% for, respectively, age group one vs. two vs. three (p = 0.018). In the multivariable logistic regression, age group one (Odds Ratio (OR) 4.73, 95% CI 1.44–18.65, p = 0.015) and 2 (OR 2.94; 95% CI 1.23–7.29; p = 0.017) were independent predictors for urinary continence, compared to age group three. Conclusion: Younger age, especially ≤60 years, was associated with better urinary continence after robotic-assisted radical prostatectomy. This observation is important at the point of patient education and should be discussed in informed consent.
... Urinary incontinence after radical prostatectomy (RP) remains a bothersome complication for pros-tate cancer (PCa) patients and is frequently associated with a substantial loss of quality of life in affected patients [1][2][3][4][5]. In the past, extensive research has been conducted to identify preoperative factors which are likely to affect postoperative urinary continence, such as body mass index (BMI), age or prostate volume [6][7][8][9][10]. ...
Introduction:
The aim of this article was to test the impact of diabetes mellitus (DM) on short-term urinary continence in patients undergoing radical prostatectomy (RP).
Material and methods:
We relied on an institutional tertiary-care database to identify patients who underwent RP between 11/2018 and 02/2021 with data available on short-term urinary continence status (30-90 days post-surgery). Continence was defined as the usage of no or one safety-pad within 24 hours. Univariable and multivariable logistic regression models tested the correlation between DM and short-term continence. Covariates consisted of pathological T-stage, body mass index, prostate volume, surgical approach and nerve-sparing.
Results:
Of 142 eligible patients, 15 (11%) patients exhibited concomitant DM. Patients diagnosed with DM exhibited lower continence rates at short-term follow-up compared to patients without DM (33 vs 63%, p = 0.03). In univariable and multivariable logistic regression models, DM was strongly associated with reduced chances of short-term urinary continence recovery (multivariable odds ratio [OR]: 0.26, 95%-CI: 0.07-0.86; p = 0.03). Furthermore, pathological T-stage (pT3/pT4) was additionally associated with reduced chance of urinary continence in logistic regression models (multivariable OR: 0.43, 95%-CI: 0.19-0.94; p = 0.04). Other covariables failed to reach statistical significance in multivariable logistic regression analyses predicting urinary continence.
Conclusions:
DM was associated with lower chances of short-term urinary continence recovery in a contemporary cohort of patients undergoing radical prostatectomy. Patients with DM should be preoperatively informed and intensified, postoperative pelvic floor training should be considered in this subgroup of RP patients.
... Radical prostatectomy (RP) is one of the main definite treatment modalities for clinically localized and locally advanced prostate cancer (PCa) and provides favorable cancer control [1][2][3][4][5]. Despite the fact that cancer control represents the unnegotiable central aim in RP, ensuring acceptable functional outcomes is of utmost importance, too [2,[6][7][8]. Among those, postprostatectomy urinary incontinence is a frequent complication occurring in 4-20% of patients undergoing RP, depending on the various definitions of continence and follow-up time [1,2,9,10]. ...
The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1–2, 4% 3–5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51–27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.
... Urinary incontinence after radical prostatectomy (RP) has consistently been reported as a bothersome complication for prostate cancer (PCa) patients and is associated with a substantial loss of quality of life in affected patients [1][2][3][4]. Besides different patient characteristics that have been postulated as potential risk factors for post-RP urinary incontinence, anatomical features based on preoperative multiparametric magnetic resonance imaging (mpMRI) have been suggested to be associated with urinary continence [5][6][7][8]. ...
Background:
To test the impact of urethral sphincter length (USL) and anatomic variants of prostatic apex (Lee-type classification) in preoperative multiparametric magnet resonance imaging (mpMRI) on mid-term continence in prostate cancer patients treated with radical prostatectomy (RP).
Methods:
We relied on an institutional tertiary-care database to identify patients who underwent RP between 03/2018 and 12/2019 with preoperative mpMRI and data available on mid-term (>6 months post-surgery) urinary continence, defined as usage 0/1 (-safety) pad/24 h. Univariable and multivariable logistic regression models were fitted to test for predictor status of USL and prostatic apex variants, defined in mpMRI measurements.
Results:
Of 68 eligible patients, rate of mid-term urinary continence was 81% (n = 55). Median coronal (15.1 vs. 12.5 mm) and sagittal (15.4 vs. 11.1 mm) USL were longer in patients reporting urinary continence in mid-term follow-up (both p < 0.01). No difference was recorded for prostatic apex variants distribution (Lee-type) between continent vs. incontinent patients (p = 0.4). In separate multivariable logistic regression models, coronal (odds ratio (OR): 1.35) and sagittal (OR: 1.67) USL, but not Lee-type, were independent predictors for mid-term continence.
Conclusion:
USL, but not apex anatomy, in preoperative mpMRI was associated with higher rates of urinary continence at mid-term follow-up.
... Another plausible explanation is that surgeons tend to downplay the risk of adverse effects and their severity to avoid worries or are oblivious to how severe the patients actually perceive their problems. There are several studies showing that clinicians underestimate the severity of their patients' adverse effects [20][21][22][23]. This explanation may also apply to the association between worse EPIC scores and poorer ratings of the quality of help received. ...
Patient-reported data are important for quality assurance and improvement. Our main aim was to investigate the association between patient-reported symptoms among patients undergoing radical prostatectomy and their perceived quality of information before treatment. In this single-centre study, 235 men treated with robotic-assisted radical prostatectomy (RARP) between August 2017 and June 2019, responded to a follow-up questionnaire 20–42 months after surgery. A logistic regression analysis was performed to assess the association between patient-reported symptoms, measured with Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), and the perceived quality of information. Adverse effects were defined as a higher EPIC score at follow-up than at baseline. The majority (77%) rated the general information as good. Higher EPIC-CP at follow-up was significantly associated with lower perceived quality of information, also after adjustment for age and level of education (bivariate model OR 1.12, 95% CI 1.07; 1.16, p < 0.001 and multiple model OR 1.12 95% CI 1.08; 1.17, p < 0.001). The share who rated information as good was almost identical among those who reported more symptoms after treatment and those who reported less symptoms (78.3% and 79.2%). Consequently, adverse effects could not explain the results. Our findings suggest a need for improvement of preoperative communication.
