Utilization of Surgery for Post-prostatectomy Incontinence

Marc Nelson, Ryan Dornbier, Eric Kirshenbaum, Emanuel Eguia, Patrick Sweigert, Marshall Baker, Ahmer Farooq, Kevin T McVary, Chris M Gonzalez, Gopal Gupta, Larissa Bresler
Journal of Urology 2019 October 23, : 101097JU0000000000000618

PURPOSE: Stress urinary incontinence (SUI) following radical prostatectomy (RP) is common and potentially debilitating. For men who fail conservative measures to treat post-prostatectomy incontinence (PPI), surgical therapy with either a urethral sling or artificial urinary sphincter (AUS) is an effective option with high patient satisfaction. We sought to characterize the contemporary utilization of surgical therapy for PPI using an all-payer database.

METHODS: The Healthcare Cost and Utilization Project Databases for Florida from 2006-2015 were utilized. International Classification of Disease procedure codes were used to identify men who underwent RP between 2006 and 2012. Patients were tracked longitudinally for ambulatory or inpatient urethral sling or AUS placement between 2006 and 2015. Patient and clinical data were extracted and analyzed with descriptive statistics. A multivariable logistic regression model was utilized to determine risk-adjusted predictors of subsequent incontinence surgery.

RESULTS: 29,287 males underwent RP during the study period. Of these, 1,068 (3.6%) had subsequent incontinence surgery, at a median of 23.5 months following prostatectomy. On multivariate analysis, risk factors for incontinence surgery included age group 61-70 years (OR 1.25, p=0.008), 71-80 (1.34, p=0.022), Medicare insurance (1.33, p<0.005)), and increased Charlson Comorbidity Index (OR 1.13/unit increase, p<0.005).

CONCLUSION: 3.6% of patients who undergo RP will have subsequent SUI surgery. Based on previously reported prevalence of severe PPI and the natural history of symptoms, PPI surgery is likely underutilized and delayed in performance. Efforts to increase prompt repair of refractory or severe incontinence can greatly improve patients' quality of life following RP.


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