Age and risk for incontinence after radical prostatectomy

A new analysis of data from a large, consecutive series of Swedish patients suggests a very strong correlation between age at time of radical prostatectomy and risk for significant, long-term urinary leakage.

Nilsson et al. carried out a survey of 1,411 consecutive patients, all of whom underwent a radical prostatectomy (carried out by either open or robot-assisted laparoscopic technique) at the Karolinska Institute between 2002 and 2006. Their objective was to identify specific predictors of long-term urinary leakage (i.e., the use of two or more pads per day) post-surgery.

The survey was specifically designed to gain information about the relationship between urinary incontinence and such factors as age at time of surgery, educational level, body mass index (BMI), the presence of respiratory disease, prostate size, and previous transurethral resection of the prostate. Some of these factors have previously been suggested to correlate with risk for post-surgical incontinence, but available data have seemed to be conflicting.

The results of the current study showed the following:

  • Questionnaires were received from 1,288 patients (91.3 percent).
  • Completed data was available for 1,179 patients (83.5 percent).
  • The average (median) follow-up time was 2.2 years.
  • Long-term urinary leakage is associated with age at time of surgery
    • There is an exponential, age-related increase in risk for long-term urinary leakage.
    • The estimated relative increase in risk is 6 percent per year.
  • Among the oldest patients, 19 percent had urinary incontinence (compared with 6 percent among patients in the youngest age group).
  • Other factors that increased risk for long-term urinary leakage included
    • Low (as opposed to high) educational level
    • The application of salvage radiation therapy
    • The presence of chronic respiratory disease (e.g., asthma or COPD).
  • The following factors appeared to have no influence on risk for long-term urinary leakage
    • Body mass index
    • Prostate weight
    • Presence of diabetes
    • A prior transurethral resection of the prostate

In drawing their conclusions, the authors note the possibility that these data may be relevant to the prevalence of urinary leakage if a radical prostatectomy is postponed as a consequence of a patient’s long-term participation in an active surveillance initiative.

Since we have only been able to review the abstract of this paper and not the full text, the age range of the patients in this study was not available to us. However, it should be noted that if the recent data from the PIVOT study and the long-term Scandinavian study of radical prostatectomy vs. watchful waiting are taken into account, almost no patients of > 65 years of age with low-risk prostate cancer are appropriate candidates for  radical prostatectomy, and such a change in clinical practice might have significant impact on the findings from this current study.

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