Continence after Radical Prostatectomy

I read an article today in the Journal of Neurourology and Urodynamics that appears to be a realistic counterpoint to the optimistic predictions from urologists and medical practitioners regarding the likelihood of a bloke being incontinent after a radical prostatectomy.

Many of my clients tell me the advice they received gave them a 10-20 percent chance of incontinence following the procedure, and that it might take months to come good (following an early period when almost all men have continence problems in the first four to six weeks of recovery). My clinical observations suggested this might be much higher. But then, I see those blokes who are struggling with the problem.

The study analyzed data from 1990 to 2007 and found that 90.3% of 1,616 men who underwent a radical prostatectomy without any radiation or hormonal treatment remained incontinent at 12 months post surgery.  The researchers cautioned that this needs to followed up with other large studies to confirm their findings chiefly because they could only follow up 37% of those who underwent surgery.  A further 4367 blokes were not fully followed up after surgery.

Perhaps of most interest to me was their attempt to link the ongoing incontinence to a range of independent factors. Having looked at the stage of the prostate cancer, the blood loss during surgery, the nerve sparing status at surgery and age of the men, the only one of these factors that correlated with the incontinence was age.  Sparing of the nerves did not make a significant difference.

Obviously more research is needed. For example, is the outcome different if the men undergo pelvic floor training before and/or after surgery?  A study along these lines is currently being done in Australia on the Sunshine Coast, but data is not in yet.

Ref:  Petersen A., Chen Y., 2012. Patient reported incontinence after radical prostatectomy is more common than expected and not associated with the nerve sparing technique: Results from the  Center of Prostate Disease Research Database.  J Neurourol0gy & Urodynamics, 31(1):60-63