Urinary incontinence and use of incontinence surgery after radical prostatectomy: a national study using patient-reported outcomes

Objectives: To investigate whether patient-reported urinary incontinence (UI) and bother scores after radical prostatectomy (RP) result in subsequent intervention with UI surgery.

Patients and methods: Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative data were used to identify men who had undergone a RP and those who subsequently underwent a UI procedure. The National Prostate Cancer Audit database was used to identify men who had also completed a post-treatment survey. These surveys included the Expanded Prostate Cancer Composite Index (EPIC-26). The frequency of subsequent UI procedures, within 6 months of the survey, was explored according to EPIC-26 UI scores. The relationship between 'good' (≥75) or 'bad' (≤25) EPIC-26 UI scores and perceptions of urinary bother was also explored (responses ranging from 'no problem' to 'big problem' with respect to their urinary function).

Results: We identified 11 290 men who had undergone a RP. The 3-year cumulative incidence of UI surgery was 2.5%. After exclusions, we identified 5165 men who had also completed a post-treatment survey after a median time of 19 months (response rate 74%). A total of 481 men (9.3%) reported a 'bad' UI score and 207 men (4.0%) also reported that they had a big problem with their urinary function. In all, 47 men went on to have UI surgery within 6 months of survey completion (0.9%), of whom 93.6% had a bad UI score. Of the 71 men with the worst UI score (zero), only 11 men (15.5%) subsequently had UI surgery.

Conclusion: In England, there is a significant number of men living with severe, bothersome UI after RP, and an unmet clinical need for UI surgery. The systematic collection of patient-reported outcomes could be used to identify men who may benefit from UI surgery.