Urinary incontinence after radical prostatectomy in Germany: real-world
results of a large rehabilitation center in 2016 and 2022
Abstract
Introduction: Despite constant improvements, incontinence is
one of the most relevant and quality-of-life-reducing side effects of
radical prostatectomy (RP) and, in addition to patient-specific factors
such as age, the experience of the surgeon/center and the surgical
technique used play an important role. Aim of the study was to present
current real-world data on incontinence after RP from one of the largest
German rehabilitation centers in 2022 and to compare it to the results
from the same institution in 2016. Material and Methods:
Retrospective, unicentric, univariate analysis of data from 1394 men
after RP in 2022 at admission and discharge. Incontinence defined as ≥1
pad/day was evaluated by quantitative measuring all day incontinence
under a defined graduation and compared to the results of 2016.
Results: Median age for both cohorts was 66 years with minor
differences in preoperative PSA levels. Despite different surgical
approaches, no significant change in postoperative incontinence rates in
2016 and 2022 were noted at discharge (76.9 vs. 77.9%, p=0.56). A
notable increase in patients with Gleason score 3+4 and a shift towards
robotic surgery were observed in 2022. While nerve sparing led to a
significant improvement in continence (p < 0.01),
lymphadenectomy and T-stage were not related to any significant increase
in incontinence rates. Comparing age groups within the cohort, patients
>69 years exhibited the highest risk of postoperative
incontinence and least likelihood of regaining continence during
rehabilitation (p < 0.01). Men treated at a certified prostate
cancer center had significantly (p<0.01) lower incontinence
rates. Conclusion: Our study shows little improvement in short
term post-operative incontinence rates after radical prostatectomy in
Germany in the last six years and known risk factors for post-operative
incontinence like age, nerve-sparing surgery and level of experience
were reproduced in our analyses. We conclude to carefully select
patients for RP and to strongly advice treatment at certified centers.