Treatment of post-prostatectomy urinary incontinence and erectile dysfunction: there is insufficient utilisation of care in German cancer survivors

Angelika Borkowetz,Christer Groeben,Falk Hoffmann,Felix K. H. Chun,Johannes Huber,Rainer Koch,Martin Baunacke,Maria-Luisa Schmidt,Lothar Weissbach,Christian Thomas

doi:10.1007/s00345-020-03526-z

Abstract

PurposeTreatment of post-prostatectomy urinary incontinence (UI) and erectile dysfunction (ED) increases quality of life (QoL). Aim of our study was to evaluate the utilisation of care among patients with post-prostatectomy UI and ED in Germany.MethodsThe HAROW study documented treatment of patients with localised prostate cancer (≤ T2c) in Germany. 1260 patients underwent radical prostatectomy (RP). Patients answered validated questionnaires after a median follow-up of 6.3 years. Response rate was 76.8%.ResultsMedian age at RP was 65 (IQR 60–69) years. 14% (134/936) used more than one pad per day for UI. 25% (26/104, 30 missing) of UI patients underwent surgery to improve continence. Of patients without surgery, 41% (31/75) reported a moderate-to-severe issue concerning their incontinence with worse mental health and QoL. 81% (755/936) patients were unable to have an erection firm enough for sexual intercourse. Of all ED patients, 40% (319/793) used ED treatment regularly or tried it at least once. 49% (243/499) of patients with interest in sex never tried ED treatment. In multivariate analysis, patients not using ED treatments were older (≥ 70 years OR 4.1), and more often had preoperative ED (OR 2.3) and less interest in sex (OR 2.2). Nevertheless, 30% (73/240) of these patients had moderate-to-severe issues with their ED reporting worse mental health and QoL.ConclusionAlmost half of the patients without post-prostatectomy UI and ED treatment reported moderate-to-severe issues with a significant decrease in QoL. This indicates an insufficient utilisation of care in Germany.

Highlights

Urinary incontinence (UI) and erectile dysfunction (ED) are the two most relevant side effects after radical prostatectomy (RP)
This study evaluated the utilisation of care for post-prostatectomy UI and ED in a large cohort of patients undergoing routine care in Germany. 25% (26/104) of incontinent patients underwent surgery to improve continence
Half of UI patients never utilising treatment for post-prostatectomy UI reported moderate to large problems because of their impairment with a significant decrease in mental health and quality of life

Summary

Introduction

Urinary incontinence (UI) and erectile dysfunction (ED) are the two most relevant side effects after radical prostatectomy (RP). Reported UI rates after RP vary between four and 40% [1], and ED rates vary between 10 and 69% [2]. Both functional outcomes are of critical importance for future quality of life [3]. In the majority of patients, UI can be treated by conservative and surgical treatment. For patients with persistent incontinence after one year of conservative treatment, including treatment with drugs, a surgical intervention can be used to improve their urinary continence [4]. There is a wide range of surgically implantable devices, including adjustable and non-adjustable male slings as well as artificial sphincters [5].

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