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. 2023 Nov 8:58:47-54.
doi: 10.1016/j.euros.2023.09.014. eCollection 2023 Dec.

Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence?

Maike H J Schepens  1   2 , Miranda L van Hooff  3   4 , Onno van der Galiën  5 , Cathelijne M P Ziedses des Plantes  6 , Diederik M Somford  7   8 , Pim J van Leeuwen  9 , Martijn B Busstra  10 , Sjoerd Repping  11 , Michel W J M Wouters  1   12   13 , Jacques van Limbeek  14
Affiliations

Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence?

Maike H J Schepens et al. Eur Urol Open Sci. .

Abstract

Background: On the basis of previous analyses of the incidence of urinary incontinence (UI) after radical prostatectomy (RP), the hospital RP volume threshold in the Netherlands was gradually increased from 20 per year in 2017, to 50 in 2018 and 100 from 2019 onwards.

Objective: To evaluate the impact of hospital RP volumes on the incidence and risk of UI after RP (RP-UI).

Design setting and participants: Patients who underwent RP during 2016-2020 were identified in the claims database of the largest health insurance company in the Netherlands. Incontinence was defined as an insurance claim for ≥1 pads/d.

Outcome measurements and statistical analysis: The relationship between hospital RP volume (HV) and RP-UI was assessed via multivariable analysis adjusted for age, comorbidity, postoperative radiotherapy, and lymph node dissection.

Results and limitations: RP-UI incidence nationwide and by RP volume category did not decrease significantly during the study period, and 5-yr RP-UI rates varied greatly among hospitals (19-85%). However, low-volume hospitals (≤120 RPs/yr) had a higher percentage of patients with RP-UI and higher variation in comparison to high-volume hospitals (>120 RPs/yr). In comparison to hospitals with low RP volumes throughout the study period, the risk of RP-UI was 29% lower in hospitals shifting from the low-volume to the high-volume category (>120 RPs/yr) and 52% lower in hospitals with a high RP volume throughout the study period (>120 RPs/yr for 5 yr).

Conclusions: A focus on increasing hospital RP volumes alone does not seem to be sufficient to reduce the incidence of RP-UI, at least in the short term. Measurement of outcomes, preferably per surgeon, and the introduction of quality assurance programs are recommended.

Patient summary: In the Netherlands, centralization of surgery to remove the prostate (RP) because of cancer has not yet improved the occurrence of urinary incontinence (UI) after surgery. Hospitals performing more than 120 RP operations per year had better UI outcomes. However, there was a big difference in UI outcomes between hospitals.

Keywords: Outcomes; Prostate cancer; Radical prostatectomy; Urinary incontinence; Volume-outcome relationship.

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Figures

Fig. 1
Fig. 1
Boxplots of the number of radical prostatectomy (RP) procedures per hospital per year showing the median, range, interquartile range, and number of hospitals performing RP.
Fig. 2
Fig. 2
Flow chart of the study populations for assessing the incidence of RP-UI at a national level, variations in RP-UI incidence among hospitals, and the risk of RP-UI. RP = radical prostatectomy; RP-UI = urinary incontinence after RP.
Fig. 3
Fig. 3
Mean proportion of patients with urinary incontinence 12–15 mo after radical prostatectomy (RP) by year. Differences in the rate of urinary incontinence after RP at a national level were not significant (χ2 = 1.38, p > 0.05).
See this image and copyright information in PMC

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