Long-term Urinary Incontinence Research Articles

Daily urine loss immediately after urethral catheter removal may be an effective predictor of long-term urinary incontinence following robot-assisted laparoscopic radical prostatectomy.

Some patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) continue to experience long-term urinary incontinence (UI). This study aimed to evaluate easily obtainable factors that can predict long-term UI following RARP. A total of 315 patients who underwent RARP for localised prostatic cancer were analysed. We separated the patients into two groups, namely, the Continence group and the Incontinence group, according to the presence or absence of UI at 12months after surgery, and we compared the patients' characteristics and operative data to identify clinical signs associated with long-term UI. Additionally, correlations between these factors and postoperative urethral function were evaluated. Urinary continence was defined as both the use of 0 pads/per day and <2g of urine lost using the 24-hours pad weight test. Of 315 patients, 250 (79.4%) achieved urinary continence and 65 (20.6%) had long-term UI. Age, storage-related lower urinary tract symptoms before surgery, nerve-sparing surgery and the 24-hours urine loss immediately after urethral catheter removal significantly affected long-term UI after RARP. Multivariate logistic regression analyses revealed that the 24-hours urine loss after catheter removal was a significant predictor of long-term UI. Receiver operating characteristic curve analysis identified a urine loss of 330g/d as the optimal cut-off value, which yielded 92% sensitivity and 84% specificity, and it showed significant correlations with postoperative urethral function and the time to recover urinary continence. The 24-hours urine loss immediately after urethral catheter removal may be the most reliable and useful predictor of long-term UI following RARP.

Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus

BackgroundPelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated.MethodsThe Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24–26 weeks, with a follow-up at 34–38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24–48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy.DiscussionTo our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.

The comparison of transurethral versus suprapubic catheter after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

The transurethral catheter (TUC) or supra-pubic catheter is commonly used after robot-assisted radical prostatectomy (RARP). However, the best way of urine drainage after the operation is still controversial. A comprehensive search of PubMed, Cochrane, Web of Science databases and the reference lists of relevant articles was performed up to July 2019. This systematic review and meta-analysis was performed based on all randomized controlled trials (RCTs) and retrospective studies assessing the two techniques. In total, nine studies (1,121 patients) were eligible, including three RCTs, one prospective and five retrospective studies. After RARP, postoperative pain was less in suprapubic catheter (SPC) group than TC group, both within 3 days [mean difference (MD): -0.70; 95% confidence interval (CI): -1.37 to -0.02; P=0.04] and 5 days after operation (MD: -0.96; 95% CI: -1.39 to -0.52; P<0.00001). There was no significant difference between SPC and TUC groups, in operation time (MD: 2.58; 95% CI: -5.82 to 10.97; P=0.55) and at rates of both catheterization-associated complication [odds ratio (OR): 1.05; 95% CI: 0.67 to 1.64; P=0.83] and long-term urinary incontinence (OR: 0.69; 95% CI: 0.42 to 1.12; P=0.13). Patients in SPC group suffer from less postoperative pain compared with the TUC group. SPC can be a better alternate of TUC.

Can planned caesarean section prevent long-term urinary stress incontinence in twin pregnancy?

Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicenter randomised trial. Hutton at al., for the Twin Birth Study Collaborative Group, BJOG 2018;125:1682–90. To view this article visit https://doi.org/10.1111/1471-0528.15407 You are caring for a woman who is 32 weeks into her first pregnancy with dichorionic diamniotic (DCDA) twins. The pregnancy is uncomplicated and the first twin is cephalic. How do you plan her delivery? Women between 320/7 and 386/7 weeks of gestation with diamniotic twin pregnancy, where the first twin was in the cephalic position. Planned caesarean section. Planned vaginal delivery. Urinary stress incontinence, or fecal or flatal incontinence at 2 years. Perspective longitudinal study. For women with twins, compared with planned vaginal birth, planned caesarean is associated with a decreased prevalence (odds ratio, OR 0.63; 95% confidence interval, 95% CI 0.47–0.83) but not severity of urinary stress incontinence at 2 years. Hill KG, Woodward D, Woelfel T et al. Planning for long-term follow-up: strategies learned from longitudinal studies. Prev Sci 2016;17:806. Barret et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013;369:1295–1305.

Salvage radiotherapy after radical prostatectomy: Long-term results of urinary incontinence, toxicity and treatment outcomes

PurposeFor patients with local recurrent disease after radical prostatectomy (35–54%) salvage radiotherapy (SRT) is the treatment of choice. In the post prostatectomy setting, SRT may impose risk at increased toxicity. As data on long-term toxicity, especially on urinary incontinence, are scarce, we report on the long-term treatment outcomes, toxicity and urinary incontinence rates after SRT. Materials and methodsPatients with biochemically recurrent prostate cancer after radical prostatectomy, who were treated with SRT (3D-CRT) at our institution between 1998 and 2012, were included in this retrospective cohort analysis. Primary endpoint was urinary incontinence rate. Secondary endpoints were acute and late grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicity rates, biochemical progression-free survival (bPFS), distant metastasis-free survival (DMFS), disease specific survival (DSS), and overall survival (OS). Results244 patients were included. Median follow-up after SRT was 50 months (range: 4–187 months). Before start of SRT 69.7% of patients were continent for urine. After SRT de novo urinary incontinence complaints (grade ≥ 1) occurred in the respective acute and late phase in 6.1% and 17.6% of patients. Respective acute grade ≥2 GU and GI toxicity was 19.2% and 17.6%. Late grade ≥2 toxicity for GU was 29.9% and for GI was 21.3%, respectively. The respective 5-year bPFS, OS, DSS and DMFS rates were 47.6%, 91.8%, 98.8% and 80.5%. ConclusionsExperience at our institution with SRT demonstrates that this results in good long-term biochemical control. However, toxicity and urinary incontinence rates were high.

PO-0826: Factors affecting self-reported, long-term (1-2 yrs) urinary incontinence from post-prostatectomy RT

PO-0826: Factors affecting self-reported, long-term (1-2 yrs) urinary incontinence from post-prostatectomy RT

1155 - Factors affecting self-reported, long-term (1-2 yrs) urinary incontinence from postprostatectomy RT

1155 - Factors affecting self-reported, long-term (1-2 yrs) urinary incontinence from postprostatectomy RT

Impact of Obesity on Long-Term Urinary Incontinence after Radical Prostatectomy: A Meta-Analysis.

Obesity is a known risk factor for prostate cancer progression and may contribute to poor treatment outcomes. However, little is known concerning the relationship between obesity (body mass index [BMI] ⩾ 30) and the urinary incontinence (UI) of patients after radical prostatectomy (RP). The goal of this study was to focus on the prevalence and duration of UI after RP with specific attention to the BMI. Subsequently, trials were identified in a literature search of PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting BMI, study characteristics, and outcome data including the relationship between BMI and urinary incontinence data were included. Finally, four studies comprising 6 trials with 2890 participants were included. The results showed that obesity increased UI risk at 12 months in patients who underwent robotic-assisted laparoscopic radical prostatectomy (RLRP) (odds ratio [OR] 2.43, 95% confidence interval [CI] [1.21, 4.88], P = 0.01). When stratified by the surgical methods, the pooled results showed that obesity increased UI risk at 24 months in patients who underwent RLRP (OR 2.00, 95% CI [1.57, 2.56], P < 0.001). However, in patients who underwent laparoscopic radical prostatectomy (LRP), the pooled results showed that obesity does not increase UI risk at 24 months (OR 1.13, 95% CI [0.74, 1.72], P = 0.58). This is the first study to include obesity as the primary independent variable. Outcomes indicate that obesity (BMI ≥ 30) may increase the UI risk at 12 and 24 months after RLRP. Well-designed randomized controlled trials with strict control of confounders are needed to make results comparable.

Robotic-assisted Sacrocolpopexy with versus without Concomitant Midurethral Sling: A 2-year Follow-up of Urinary Symptoms and Quality of Life.

Objective:The objective of this study was to assess long-term postoperative urinary incontinence (UI) symptoms and quality of life (QOL) in patients after robotic-assisted sacrocolpopexy (RASC) with or without concomitant midurethral sling (MUS).Materials and Methods:This is a cross-sectional survey of patients comparing long-term postoperative urinary symptoms and QOL measurements in women who underwent RASC with or without MUS. We included all patients from 2011 to 2014 who had RASC with or without MUS. All patients had preoperative urodynamic testing (UDS). Patients who demonstrated stress UI on UDS underwent MUS at the time of RASC. Urinary symptoms and QOL were assessed through the validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) patient questionnaires.Results:Sixty-eight patients met inclusion criteria, 46 patients completed follow-up questionnaires, and were included in the final analysis. Average length of time to follow-up from surgery was 24 months (range: 6–36 months). A statistically significant difference in UDI-6 scores between the two groups (RASC vs. RASC + MUS) was observed. Median (25th and 75th percentiles) scores for UDI-6 were 22.92 (8.33 and 32.29, respectively) for the RASC group and 4.17 (0 and 13.54, respectively) for the RASC + MUS group (P = 0.0017). Median scores for IIQ-7 were 0 (0 and 29.73 for the 25th and 75th percentiles, respectively) for the RASC group and 0 (0 and 0, respectively) for the RASC + MUS group (P = 0.1691).Conclusion:Patients who underwent RASC + MUS scored significantly lower on the UDI-6, indicating fewer urinary distress symptoms. Although not statistically significant, patients in the RASC + MUS group had lower IIQ-7 scores, indicating less negative impact on QOL, compared to the RASC-only group.

MP14-15 CLINICO-DOSIMETRIC FACTORS PREDICTING LONG-TERM SEVERE URINARY INCONTINENCE AFTER POST-PROSTATECTOMY RT. RESULTS OF A LONGITUDINAL OBSERVATIONAL STUDY.

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2016MP14-15 CLINICO-DOSIMETRIC FACTORS PREDICTING LONG-TERM SEVERE URINARY INCONTINENCE AFTER POST-PROSTATECTOMY RT. RESULTS OF A LONGITUDINAL OBSERVATIONAL STUDY. Barbara Noris Chiorda, Carla Sini, Claudio Fiorino, Alberto Briganti, Anna Chiara, Chiara Lucrezia Deantoni, Nicola Fossati, Giorgio Gandaglia, Nazareno Suardi, Francesco Montorsi, Nadia Di Muzio, and Cesare Cozzarini Barbara Noris ChiordaBarbara Noris Chiorda More articles by this author , Carla SiniCarla Sini More articles by this author , Claudio FiorinoClaudio Fiorino More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Anna ChiaraAnna Chiara More articles by this author , Chiara Lucrezia DeantoniChiara Lucrezia Deantoni More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Nadia Di MuzioNadia Di Muzio More articles by this author , and Cesare CozzariniCesare Cozzarini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2518AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The fear of RT-induced urinary incontinence (URINC) often controindicates post-prostatectomy RT (POPRT), despite the lack of accurate data about its real incidence and severity. Purpose of this study was to analyze clinico-dosimetric factors predicting severe, self-reported, URINC 1 and 2 after POPRT. METHODS In 2012 an observational study aimed at assessing URINC from POPRT including WPRT was activated. 2 validated questionnaires, IPSS and ICIQ-SF, have to be filled-in by pts at baseline, at RT mid-point and end, at 3 and 6 months after RT end, and every 6 months thereafter. This analysis pertains to the first 101 pts correctly filling the questionnaires at baseline and at 12 months (60 also at 2 years). 54 and 47 pts were treated with ADV and SALV intent after a median of 4 and 38 months, respectively, from RP, with either conventional (n=42) or moderately hypofractionanted (n=59) regimens, at a median 2-Gy equivalent dose (EQD2) to the prostatic bed of 70 and 74 Gy in ADV and SALV cohort, respectively, and a median EQD2 dose of WPRT of 50 Gy. RESULTS The baseline mean ICIQ score was 7.8 and 4.8 in ADV and SALV cohorts, respectively (p=0.009). The corresponding values at 1 and 2 years were 7.4 vs 7.3 and 8.5 vs 7.9, respectively. Severe URINC (( 13 points) was recorded in 23 and 19%, at 1 year, and in 37 and 21%, at 2 years, of pts treated with ADV and SALV intent, respectively (p always (0.20). The 75th quartiles of ICIQ at 12 (ICIQ12) and 24 (ICIQ24) months (12 and 13 points, respectively), were set as end-points for regression logistic analysis. Of note, the “most informative cut-off” of baseline ICIQ with respect to the risk of ICIQ12 was (16 (AUC 86%) and (7 (AUC 87%) in ADV and SALV cohorts, respectively. CONCLUSIONS The risk of long-term severe URINC one and two years after POPRT was higher in pts treated with ADV intent as compared to the SALV cohort, though only pts with extremely severe baseline incontinence in the ADV subgroup experienced a significant risk of ICIQ12. Overall, the risk of ICIQ12 and ICIQ24 is strongly modulated by baseline URINC, and by AAD and higher EQD2, respectively (Figure 1). © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e149 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Barbara Noris Chiorda More articles by this author Carla Sini More articles by this author Claudio Fiorino More articles by this author Alberto Briganti More articles by this author Anna Chiara More articles by this author Chiara Lucrezia Deantoni More articles by this author Nicola Fossati More articles by this author Giorgio Gandaglia More articles by this author Nazareno Suardi More articles by this author Francesco Montorsi More articles by this author Nadia Di Muzio More articles by this author Cesare Cozzarini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

682 Clinico-dosimetric factors predicting long-term severe urinary incontinence after post-prostatectomy RT: Results of a longitudinal observational study

682 Clinico-dosimetric factors predicting long-term severe urinary incontinence after post-prostatectomy RT: Results of a longitudinal observational study

Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up

ObjectiveTo compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. Study designLong-term follow-up of a randomized clinical trial of subtotal vs. total abdominal hysterectomy with objective outcomes. All randomized women still alive and living in Denmark (n=304) were invited to answer a questionnaire and come for clinical examination consisting of 20-min pad weighing test, urinary flow, measurement of residual urine, POP-Q measurement for pelvic organ prolapse, 3 day voiding diary and also filled out the pelvic floor distress inventory (PFDI-20) questionnaire. ResultsWe included 100/304 (32.9%) women (subtotal hysterectomy: 53, total hysterectomy: 47) in the clinical examinations. The study questionnaire was answered by 197 (64.8%) (subtotal: 97, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group, 31 (59.6%) women had objective stage 2 pelvic organ prolapse compared with 33 (70.2%) in the total hysterectomy group (P=0.27); however, only 6/31 and 9/33 had symptoms (P=0.45). There were more anterior pelvic organ prolapses in the total hysterectomy group (N=10) than in the subtotal hysterectomy group (N=4) (P=0.048). We found a higher mean maximum flow rate (Qmax) in the subtotal hysterectomy group (34.78ml/s) than in the total hysterectomy group (27.08ml/s) (P=0.042) as well as a higher mean functional capacity in the subtotal hysterectomy group (526ml) than in the total hysterectomy group (443ml) (P=0.0147) according to the voiding diary. ConclusionSubtotal and total abdominal hysterectomy are comparable regarding long-term objective pelvic organ prolapse and urinary incontinence. The subtotal hysterectomy group had a higher Qmax and voided volume.

Algorithm-based multidisciplinary treatment approach for rectourethral fistula

The purpose of this study is to report the outcomes of an algorithm-based multidisciplinary treatment approach to rectourethral fistula. This study is a retrospective review of a prospectively collected database at a tertiary center of all consecutive patients treated between 2003 and 2013. Thirty males (mean age 63 years) were reviewed. Prostate cancer treatment was the most common fistula etiology (97%). Urinary drainage consisted of urethral catheter in all patients and suprapubic catheter in 14 (47%). The rate of fecal diversion was 67%. During a mean follow-up of 72 months, healing rate was 90% and recurrence rate 0%. Spontaneous healing was achieved in 14 patients (47%): 8 (27%) without fecal diversion and 6 (20%) following fecal diversion. Thirteen patients (43%) required definitive intervention. The majority of operated patients underwent transanal or transperineal flap (endorectal, dartos, or gracilis) successfully. Only 2 patients (7%) required an abdominal approach (positive oncologic margins or non-functioning bladder). Fifteen out of the 20 patients (75%) who underwent fecal diversion had stoma closure with an overall permanent stoma rate of 17%. Long-term urinary incontinence was noted in 11 patients (37%). Six patients (20%) required permanent urinary diversion or drainage catheters. Algorithm-based treatment approach for rectourethral fistula is useful in the management of this rare condition. Selective fecal diversion is possible, and majority of patients who require definitive intervention can be treated with a transanal or transperineal approach. The rate of permanent stoma is low, but long-term urinary dysfunction is frequent.

Urogenital function after cloacal reconstruction, two techniques evaluated

ObjectiveCurrent surgical techniques for cloacal reconstruction are posterior sagittal anorecto vagino urethroplasty (PSARVUP) and posterior sagittal anorectoplasty (PSARP) with total urogenital mobilization (TUM). The aim of this study was to explore the results of reconstructive cloaca surgery in the Netherlands and evaluate urogenital function after PSARVUP and TUM. Patients and methodsMedical records from five pediatric surgical departments in the Netherlands were studied for patients with cloacal malformations treated between 1985 and 2009. Forty-two patients were eligible, and patients with short common channels were categorized into PSARVUP and TUM groups. Groups were compared using Fisher's exact test. ResultsMedian age at time of surgery was 9 months (range 1–121). In 24 patients (57%) a PSARVUP was done, in 18 patients (43%) TUM. Median follow-up was 142 months (range 15–289). At follow-up spontaneous voiding was seen in 29 patients (69%). Clean intermittent catheterization (CIC) was needed in 14 patients (33%); a urinary diversion was created in 10 patients (24%). In total 32 patients (76%) were dry with no involuntary loss of urine per urethra. Recurrent urinary tract infections were seen in 23 patients (55%). When comparing PSARVUP and TUM groups in our series of patients with short common channels, there were no differences in urological outcome. Normal menstruation was present in 11 of the 20 patients who reached puberty (55%). ConclusionUrogenital functional outcome after reconstructive surgery for cloacal malformations was similar in PSARVUP and TUM groups in patients with short common channels. A thorough urological follow-up is needed to establish the long-term bladder function and urinary incontinence results to prevent long-term risks of recurrent UTI. Albeit without differences between PSARVUP and TUM groups, 45% of the patients present with abnormal or absent menstruations. Gynecological follow-up is mandatory in all patients with cloacal malformations 6 months after the first sign of puberty.

Prostate brachytherapy technique and long-term urinary incontinence: 5-year outcomes of a prospective comparative cohort study.

e16016 Background: Prostate brachytherapy (BT) causes long-term urinary incontinence. Altered techniques may improve patient outcomes. Methods: We prospectively studied three Boston-area patient BT...

Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radiotherapy

Background and purposeWe describe variations across the regional cancer centres in Ontario, Canada for five prostate cancer radiotherapy (RT) quality indicators: incomplete pre-treatment assessment, follow-up care, leg immobilization, bladder filling, and portal film target localization. Along with cancer centre volume, we examined each indicator’s association with relevant outcomes: long-term cause-specific survival, urinary incontinence, and gastrointestinal and genitourinary late morbidities. Materials and methodsWe conducted a population-based retrospective cohort study of 924 prostate cancer patients diagnosed between 1990 and 1998 who received RT within 9months of diagnosis. Data sources included treating charts and registry and administrative data. The associations between indicators and outcomes were analysed using regression techniques to control for potential confounders. ResultsPractice patterns varied across the regional cancer centres for all indicators (p<0.0001). Incomplete pre-treatment assessment was associated with worse cause-specific survival although this result was not significant when adjusted for confounding (adjusted RR=1.78, 95% CI=0.79–3.98). Treatment without leg immobilization (adjusted RR=1.72, 95% CI=1.16–2.56) and with an empty bladder (adjusted RR=1.98, 95% CI=1.08–3.63) was associated with genitourinary late morbidities. Treatment without leg immobilization was also associated with urinary incontinence (adjusted RR=2.18, 95% CI=1.23–3.87). ConclusionsWe documented wide variations in practice patterns. We demonstrated that measures of quality of care can be shown to be associated with clinically relevant outcomes in a population-based sample of prostate cancer patients.

Men's experiences of regaining urinary continence following robotic‐assisted laparoscopic prostatectomy (RALP) for localised prostate cancer: a qualitative phenomenological study

To understand how men interpret their experiences of regaining continence following robotic-assisted laparoscopic prostatectomy (RALP). RALP is an innovative surgical technique intended to minimise the risk of long-term postoperative urinary incontinence in localised prostate cancer. Studies have shown that urinary function and quality of life domains can be adversely affected following RALP; however, the impact on men's lives has been hitherto unreported. A qualitative study using hermeneutic phenomenology Face-to-face, in-depth audio-recorded interviews with seven men (aged 57-71) who had recently undergone RALP and defined themselves as continent of urine. Data were inductively analysed for themes using an adapted version of Diekelmann etal. [1989, The NLN Criteria of Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, 1st edn. National League for Nursing (NLN) Press, New York, NY] framework. Men's experiences of regaining continence were situated within a wider network of personal and social relationships, and cultural structures. Themes included 'what was forecast', 'after-sales service', 'new plumbing', 'sense of self'. Men adopted a variety of practical coping strategies: preventing incontinence; improving incontinence; and dealing with lack of bladder control. The need to regain a sense of control over their lives resulted in all men developing coping mechanisms in order that they could resume their societal roles, which were salient to their personal identity, inferring that men's ability to cope with incontinence after RALP was dependent on factors other than urinary leakage alone. Knowledge of the potential impact of RALP could help nurses tailor appropriate interventions. Incontinence is individually interpreted and may not be well-addressed by traditional 'one-size fits all' preoperative programmes or information. Flexible and imaginative options (e.g., activity-focused interventions; buddy systems; internet programmes; telephone follow-up) for preoperative and postoperative support and activities for men may improve men's uptake of such services, through specialist nurse or peer support.

Patient and tumour-related factors for prediction of urinary incontinence after radical prostatectomy

Objective. The aim of this study was to identify preoperative patient and tumour-related factors associated with 12 months postoperative urinary incontinence. Material and methods. In total, 1529 men who had undergone radical prostatectomy for clinically localized prostate cancer between September 2008 and February 2010 at 15 Swedish hospitals completed a questionnaire before, 3 and 12 months after surgery. Urinary leakage, comorbidity and possible confounders were measured by self-administered validated questionnaires. Clinical data were collected preoperatively and postoperatively. The primary outcome, incontinence, was defined as the change of one pad or more per day. The ratio of proportions, estimated according to the log-binomial regression model, was analysed for 38 different factors and is presented as relative risks with 95% confidence intervals. Age-adjusted relative risk was calculated in the corresponding bivariate regression model. Results. Prospective data were available from 1360 men (response rate 89%). Results showed that age at surgery predicts long-term urinary incontinence exponentially. Patients reporting urinary leakage before prostate cancer diagnosis had an age-adjusted relative risk of 1.8 (95% confidence interval 1.3–2.4) for incontinence 12 months postoperatively. No statistically significant correlation was found between previous transurethral resection of the prostate, high body mass index or the other 34 evaluated factors and postoperative incontinence. Conclusions. Of 38 possible risk factors only age at surgery and preoperative urinary leakage were associated with 12 months postoperative incontinence in this study comprising 1360 men operated with radical prostatectomy. These findings may help the surgeon to have a targeted risk conversation with the patient before the treatment decision is made.

Does prostate brachytherapy that avoids the central zone prevent long-term urinary incontinence? Five-year results of a multi-institutional comparative cohort study.

4665 Background: To evaluate a prostate brachytherapy technique (XBT) designed to reduce urinary dysfunction by avoiding central prostate radiation, we prospectively compared outcomes of XBT patients to 2 standard technique (SBT) groups. Methods: We surveyed newly diagnosed, untreated patients with clinically localized prostate cancer before brachytherapy to gather clinical and quality of life information, with follow-up 1, 3, 12, 24, 36, 48 and 60 months after treatment. XBT treatment was at Brigham and Women's Hospital, SBT at Beth Israel-Deaconess or Metrowest Hospitals or at Massachusetts General Hospital. Results: As of December 2010, 263 enrolled patients with at least 3-month follow-up, including 73 XBT patients and 190 SBT patients, 99 at 1 site and 91 at the other, and 167 (63%) had completed 5-year follow-up. Tthe treatment groups were similar before treatment. For all patients, urinary obstruction/irritation was increased for 24 months but rose less and resolved earlier for XBT patients. One SBT group reported greater urinary dysfunction, but the problem resolved after a technique change. At 60 months after SBT, but not XBT, urinary incontinence appeared to rise (P=0.09). Sexual dysfunction rose for 36 months for all groups but not thereafter. Conclusions: Sharply reduced periurethral radiation suppresses post-treatment increases in urinary obstruction/irritation and may prevent long-term urinary incontinence, although definitive results may require longer follow-up. Declining sexual dysfunction appears to halt after 36 months.

Age at surgery, educational level and long‐term urinary incontinence after radical prostatectomy

To identify predictors for long-term urinary leakage after radical prostatectomy. A consecutive series of 1411 patients who underwent radical prostatectomy (open surgery or robot-assisted laparoscopic surgery) at Karolinska University Hospital between 2002 and 2006 were invited to complete a study-specific questionnaire. Urinary leakage was defined as use of two or more pads per day. Questionnaires were received from 1288 (91%) patients with a median follow-up of 2.2 years. Age at surgery predicts in an exponential manner long-term urinary incontinence at follow-up with an estimated relative increase of 6% per year. Among the oldest patients, 19% had urinary incontinence compared with 6% in the youngest age group, translating to a prevalence ratio of 2.4 (95% confidence interval [CI], 1.5-8.1). Low educational level, as compared with high, yielded an increased age-adjusted prevalence ratio of 2.5 (95% CI, 1.7-3.9). Patients who had undergone salvage radiation therapy had an increased prevalence of urinary incontinence (2.5; 95% CI, 1.6-3.8), as did those with respiratory disease (2.4; 95% CI, 1.3-4.4). Body mass index, prostate weight, presence of diabetes or previous transurethral resection did not appear to influence the prevalence of urinary incontinence. In this series, a patient's age at radical prostatectomy influenced, in an exponential manner, his risk of long-term urinary incontinence. Other predictors are low educational level, salvage radiation therapy and respiratory disease. Intervention studies are needed to understand if these data are relevant to the prevalence of urinary leakage if a radical prostatectomy is postponed in an active monitoring programme.