Presentation Authors: Divya Ajay*, Hanhan Li, Brittani Barrett-Harlow, Jenny Nguyen, Houston, TX, Cooper Benson, New Orleans, LA, Xuemei Wang, Brian Chapin, John Davis, O. Lenaine Westney, Houston, TX
Introduction: Post-prostatectomy urinary incontinence (PPUI) negatively impacts the quality of life of prostate cancer survivors. Factors governing the return of continence are poorly understood. The goal of this study is to characterize pre and intraoperative factors that contribute to a delay in regaining continence after robot-assisted laparoscopic prostatectomy (RALP) at a single tertiary cancer center.
Methods: Patients with pathologically proven, non-metastatic, T1-T3bN0 prostate cancer, treated with a curative intent by two high-volume surgeons were included in the study. Patient demographics, operative details, and postoperative continence were extracted from the electronic medical record. Time to dry is defined as the time interval between the date of prostatectomy and the first evaluation at which patients present with zero pad use. Patients were evaluated for pad usage at four time points. Patients with missing data at all evaluations were excluded. The probabilities of incontinence were estimated using the Kaplan and Meier method. Cox proportional hazards regression models were used to assess the association between time to dry and patient characteristics. All statistical analyses were conducted in SAS and Splus.
Results: From 2008 to 2015, 1350 patients were evaluated, 75 were excluded due to missing data, yielding 1275 total patients for analysis. During the follow-up period, 851 (66.7%) reported zero pad use after surgery. The median time to dry was 6 months and the median follow-up time was 32 (19-48) months. The univariate analysis demonstrated that age at RALP, race, clinical stage, pathologic stage, nerve-sparing status and number of comorbidities associated with incontinence (obstructive sleep apnea, chronic obstructive pulmonary disease, diabetes mellitus, and obesity) were significant predictors for a delay in resolution of PPUI. On multivariate analysis, the variables that remained significant after backward model selections include age at RALP, nerve-sparing status, and the number of preoperative comorbidities. Older age (p=0.0002) and more comorbidities (p=0.04) were associated with a prolonged time to regain continence, while having either unilateral (p=0.004) or bilateral (p=0.001) nerve-sparing RALP was associated with a shorter time when compared to the non-nerve sparing group. Notably, neoadjuvant androgen deprivation therapy and preoperative hypogonadism did not affect the time to dry.
Conclusions: In addition to intraoperative technical factors, this study highlights the large impact patient comorbidities have in the resolution of PPUI. This information can better guide patient counseling and framing expectations.
Source of Funding: N/A