RADICAL PROSTATECTOMY: EVOLUTION OF STRESS URINARY INCONTINENCE BEYOND THE FIRST YEAR FOLLOW UP BASED ON 24 HOURS PAD TEST

Collado Serra A1, Wong G1, Dominguez-Escrig J2, Ramirez-Backhaus M1, Mascaros Martinez J1, Gómez-Ferrer A1, MIr Maresme C1, Rodrigo Aragon F1, Casanova Ramón-Borja J1, Iborra Juan I1, Dumont Martinez R1, Rubio-Briones J1

Research Type

Clinical

Abstract Category

Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)

Abstract 4
Best Urology
Scientific Podium Session 1
Wednesday 4th September 2019
09:45 - 10:00
Hall K
Stress Urinary Incontinence Male Pad Test
1.Fundación IVO, Valencia, Spain, 2.Fundación IVO,Valencia,Spain
Presenter
A

Argimiro Collado Serra

Links

Abstract

Hypothesis / aims of study
Stress Urinary Incontinence (SUI) following radical prostatectomy(RP)  persists despite the improvement of surgical techniques (1) and it is one of the main concerns for patients who undergo this procedure.

Many factors are involved: sphincteric dysfunction after RP (among others direct injury to the sphincter or its inervation, shortening of the membranous urethra, sphincter complex displacement), bladder dysfunction or changes in the pelvic floor among others. The functional recovery of the all anatomical mechanisms involved causes continence is progressively restored within 12-24 months to years after surgery.  However, this period of time (recovery period) greatly alters the patient's quality of life. 

Many authors reports that there is little recovery in urinary continence beyond 12–24m after RP  (established incontinence period) (2). However, Lee et al publish that many RP patients continue to recover urinary continence after 12 months postopertive and the level of functional recovery by 12 months is associated with long-term recovery (3). At far, in these studies urinary continence was assessed using a questionnaire administered or pad count. However, pad test can provide additional information about degree of incontinence.  

The aims of this study is to assess our data for this period (first-second year), based on the quantification of the 24-hour pad test (PT24h).
Study design, materials and methods
Inclusion period: patients had undergone an open retropubic or laparoscopic RP from April 2011 to June 2016.

Patients included: patients with two years of follow-up after radical prostatectomy with PT24h≠ 0 at first year follow-up and not eligible for male incontinence surgery. 

Exclusion criteria: previous external beam radiotherapy, brachytherapy or prostate cancer focal therapy. Postoperative complications. Salvage radiotherapy.Loss to follow-up.

Functional Follow-up after radical prostatectomy: all patients perform a Pelvic Floor Muscle Training program (it starts three weeks before RP). Degree of incontinence was assessed with a 24-Hour Pad test and the Spanish validated version of International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF). Continence was evaluated at first and sixth weeks after RP, third and sixth month and after one (1st year PT) and two years of follow-up(2nd year PT). 

Statistical analysis: descriptive statistics and confidence interval of a mean, t test to compare two means and Spaghetti plot.
Results
Figure 1 shows the flow-chart of patients during the study. The final study group corresponded to 114 patients with the first postoperative year PT24h≠0 (1st year PT). There were no significant differences between 1st year PT (median 24g, range 2-1500) and the second year (median 20.5g, range 0-1630) (p=0.97).

At the end of the second year follow-up (2nd year PT), 100 patients had a PT=0 and 14 had a PT≠0.  In the first group (2nd year PT=0), the median 1st year PT was 14g(range 2-145) and in the second group (2nd year PT≠0) the median 1st year PT was 26 g (range 2-1500) (p=0.213). Considering the rank of the fist group (2-145g), a Spaghetti plot  was desing (figure 2).

The percentage of patients with 2nd year PT =0 according to 1st year PT was:
1st year PT <20g (47 patients): 9 patients with 2nd year PT =0 (19%)
1st year PT 20-50g (35 patients): 3 patients with 2nd year PT =0 (8.6%)
1st year PT >50g (32 patients): 2 patients with 2nd year PT =0 (6%)
No patients with 1st year PT >150 g (n=17) had 2nd year PT =0.
Interpretation of results
This work has two strengths in relation to other studies that evaluate postoperative continence in radical prostatectomy: degree of incontinence was quantitative assessed (24h PT) and all patients have a closed follow-up, with 6 pad test measurements.

According to the previous literature, in our study the probability of improvement of continence after 12 months postoperatively is low.

With the consensus of the patient, it is feasible to indicate an incontinence surgery with a fIrst year PT >50g, taking into account the greatly alters the patient's quality of life
Concluding message
The postoperative follow-up of incontinence through the pad test, allows a better knowledge of the evolution of patients after radical prostatectomy (from recovery period to established incontinence)

Data concerning the outcome of the functional recovery can help with patient counselling by offering a more accurate and individualized prediction of expected results. This allows us to facilitate the patient a correct information during follow-up and in the case of severe incontinence, start to discuss with the patient possible incontinence surgery.
Figure 1 Figure 1 Patients: Flow chart
Figure 2 Figure 2 Pad test 24 hour: spaghetti plot
References
  1. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Coughlin GD et al. Lancet Oncol. 2018 Aug;19(8):1051-1060. DOI: 10.1016/S1470-2045(18)30357-7. Epub 2018 Jul 17
  2. Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. Sacco et al. BJU Int. 2006 Jun;97(6):1234-41. DOI: 10.1111/j.1464-410X.2006.06185.x
  3. Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy. Lee et al. Eur Urol. 2015 Nov;68(5):899-905. doi: 10.1016/j.eururo.2015.07.074. Epub 2015 Aug 17.
Disclosures
Funding Argimiro Collado Serra is surgical trainer for AMS-800® and AdVance® (Boston Scientific) and Virtue® (Coloplast) , but this is not related to this study Clinical Trial No Subjects Human Ethics Committee This database ( "CAPROSIVO" or full name: MORTALIDAD CANCER ESPECIFICA, MORTALIDAD GLOBAL Y SEGUIMIENTO FUNCIONAL (CONTINENCIA Y DISFUNCIÓN ERECTIL) DE LOS PACIENTES TRATADOS CON CÁNCER DE PROSTATA EN LA FUNDACION INSITITUTO VALENCIANO ) has the approval from the ethical institutional review board (IRB approval) in COMITE DE INVESTIGACIÖN CLINICA DE LA FUNDACIÖN IVO, Valencia. SPAIN. Helsinki Yes Informed Consent Yes