How often incontinent after surgery?
Supply study: One third of men still incontinent three months after prostate removal
Patients who have undergone prostate cancer surgery fear nothing more than the loss of their ability to hold their urine. This is a legitimate concern, as urinary incontinence is the most common result of radical surgery and affects men's quality of life most severely. However, there is no reliable information on the number of men affected. This is why a current study now looks at the question of what the reality in the treatment actually looks like.
Men with prostate cancer are still not fully informed about urinary incontinence as a late consequence of the procedure before a prostate operation,"said Dr. Stephan Neubauer, urologist at the West German Prostate Center. The involuntary loss of urine affects many men, despite the fact that surgical techniques are gentle on the nerves. However, precise details of the actual frequency are missing. For example, the percentage of urinary incontinence varies greatly from study to study and depends on who determined how and when. They usually have little to do with reality,"says Dr. Neubauer.
Current study from the reality of care provision
The number of patients who are actually incontinent after the procedure is now being investigated by a current study, which was recently published in the specialist magazine "Der Urologe". To this end, a team of scientists evaluated the medical records of all patients who received follow-up treatment after previous removal of the prostate gland at the Klinik am Kurpark in Bad Wildungen in 2009. A total of 1,750 patients were evaluated at an average age of 65 years. In addition to age, the preoperative PSA value and the selected surgical procedure were recorded.
The result of the investigation cannot be clearer: Three months after the operation, two thirds of the patients were still unable to hold their urine despite rehabilitation measures such as pelvic bone training. The problem of incontinence differed in severity and ranged from slight urine loss and the wearing of pads to the permanent use of diapers. Conversely, only one-third of the men left the rehabilitation facility. The figures reflect the image that we know from our daily practice,"emphasizes the Cologne urologist. When and if the men affected will overcome their incontinence is still in the stars at this time. The longer the incontinence persists, the greater the likelihood that patients will not be able to hold the urine even after 12 months. It was also striking that there was no difference in the incidence of urinary incontinence, depending on which surgical procedure was used. Even robot-assisted surgery, which has been propagated as a particularly gentle procedure, did not protect against the dreaded loss of urine.
The high incidence of urinary incontinence as a result of surgery is all the more serious because many men with prostate cancer are still operated on unnecessarily,"emphasizes Dr. Neubauer. According to the recommendation of the guidelines, for example, in men with a low risk prostate carcinoma, it may often be sufficient to monitor the tumor closely (Active Surveillance). If treatment should nevertheless become necessary, it is important to steer the focus more towards achieving optimal healing rates with minimal side effects, according to the urologist from Cologne. It is therefore our duty to draw the patient's attention to effective but gentle treatment methods such as brachytherapy (internal radiation) in the run-up to therapy.
Lent V. Schultheis H. M., Strauß L. et al: Stress incontinence after prostatectomy in the treatment reality; urologist 2013 - 52:1104-1109