Trends in the surgical management of urinary incontinence after RP

Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States (2022)

Abstract
Purpose
To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI).

Materials and methods
We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum’s de-identified Clinformatics® Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis.

Results
Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery.

Conclusions
The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient’s comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.

After several months of PT my Uro told me that I was "definitely" not a candidate for the sling. My RO was urging me to get ART underway and said that there is rarely significant improvement in continence after nine months. After deciding to proceed with the implant there was a two month waiting period before it would be activated and I could begin radiation. In addition, the initial AUS required replacement in just two weeks.

It was a very stressful time, but I managed to get RT underway within one year from RP... at the same time as my wife was undergoing chemo for DLBCL. Fun times. This year I am celebrating the tenth, eighth, sixth, fifth and four year anniversaries of various landmarks in my cancer diagnosis and treatment.

Unrelated, but my SLAP surgery ten days ago went well and I start PT tomorrow. And if all goes well, later this year or early next year, Medicare will be paying for my third AUS surgery. I may sound cynical, but I am forever grateful that my PCa was successfully treated before it had the chance metastasize. Seriously. It was truly a blessing.

Tico, yep, that’s me, no more PRs, but still in for the distance. A few weeks before I had the AUS installed I ran a half marathon in Pittsburgh, a 2:37.

While I could have worn pads for the rest of my life (I was going through 4-6 heavy duty ones per day) what pushed me across the line were the leakage accidents that occurred when the “outlet” would be pointed to the side and miss the pad when I exerted myself. The last straw was in an art class where I was working in a sculpture, sitting on the floor, and stood up and drenched myself. The class was mostly young college women who knew that I’d had my prostate out the year before since I’d missed classes then. I just had to laugh it off and they were empathic. There’s was no question that I wanted a permanent solution after that.