Urinary continence after radical prostatectomy: the patient perspective

Abstract

Introduction: To compare the commonly used 0-1 pad definition of urinary continence for postoperative functional outcome after radical prostatectomy and the correlation with self-reported urinary continence and to determine whether a patient questionnaire can deliver more accurate continence status rates.

Material and methods: We evaluated a cohort of 873 men who underwent radical prostatectomy (RP) at the General Hospital in Vienna between 1998 and 2006. Patients were surveyed with a questionnaire regarding their postoperative outcome and postoperative urinary incontinence. Baseline and pathological factors were examined to determine whether or not they had an impact on the continence status.

Results and limitations: A total of 65.2% of men (n = 337) reported themselves to be continent, in contrast 85.1% were continent if the pad definition was applied. Of those using no pads, 93.4% considered themselves continent, while 24.5% of patients using one pad/day did. Overall, 86.5%, 9.8% and 3.7% of continent patients regained continence within 6 months, 6 to 12 months and after 1 year of RP, respectively. A total of 71.5% of men under 65 years old reported full urinary continence, while only 57.0% of men older than 65 considered themselves continent. Men < 65 years recovered full urinary control significantly faster than men older than 65 years- 3.6 versus 4.7 months. Neurovascular bundle resection has a negative effect on continence.

Conclusions: The ultimate continence status should be measured with self-administered disease specific questionnaires at 24 months after RP, as it differs from standard physician reported methods. Age and neurovascular bundle resection are variables affecting continence. We believe that patients' subjective reports of their continence are crucial and that multiple outcomes should be objectively measured. Therefore we suggest that validated questionnaires dealing with the patients' perspective postoperatively should be included in routine follow up.