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EPIC 26 Identifies Men Likely to Benefit from Surgical Interventions for Male Stress Incontinence after Radical Prostatectomy
Syed Alam, B.A., M.S.1, Ilene Staff, Ph.D.2, Tara McLaughlin, Ph.D.2, Alison Champagne, B.S.2, Joseph Tortora, M.S.2, Richard Kershen, M.D.2, Joseph Wagner, M.D.2.
1University of Connecticut, Farmington, CT, USA, 2Hartford Hospital, Department of Surgery, Hartford, CT, USA.

BACKGROUND: Despite advances in surgical techniques, radical prostatectomy continues to be associated with significant rates of postoperative urinary incontinence (UI). Based on the success rates of surgical intervention for female incontinence, male urethral slings are being used more frequently to treat post-prostatectomy incontinence, and artificial urinary sphincters (AUS) continue to play a significant role. Utilizing the UI subscale of the EPIC 26 questionnaire, we examined our success rates treating post-prostatectomy UI through postoperative surgical interventions. We further documented the number of patients who have similar rates of UI but have not had an intervention as this cohort may benefit from pro-intervention counseling after radical prostatectomy.

METHODS: Cross-referencing our IRB-approved, prospective prostate cancer database with hospital billing records, we identified patients who had undergone post-prostatectomy interventions to treat UI. A Wilcoxon Signed-Rank test was used to compare EPIC 26 UI scores obtained after prostatectomy but before UI intervention to those obtained after prostatectomy and after UI intervention, and a Wilcoxon Ranked Sum test was used to evaluate pre- and post- intervention differences between sling and AUS subgroups. Using the median UI score as a cut- off point, we identified men who demonstrated a level of post-prostatectomy incontinence similar to those who had undergone a sling procedure, yet did not undergo a UI intervention.

RESULTS: A total of 2965 patients underwent a robotic prostatectomy between July 2004 and July 2016. 48 patients had post-prostatectomy surgical interventions for UI: 39 received a sling and 9 received an AUS. EPIC 26 questionnaires for pre- and post- intervention time periods were available for 24 patients (19 sling, 5 AUS). The mean age was 63 years (range 43-75) with a median (IQR) interval between prostatectomy and UI procedure of 26 months (18, 41). Prior to undergoing a UI intervention, the median (IQR) UI score for all patients who had a UI intervention was 29.0 (22.3,43.8); 31.3 (25.0,44.3) for sling and 22.8 (4.1,41.8) for AUS (p=.111). Significant (p < .001) improvement was observed overall in UI scores pre- vs. post- intervention. The median (IQR) post-intervention UI score was 67.8 (58.5,85.5) for men receiving slings and 52.3 (19.8, 64.9) for men receiving an AUS (p=.025). For men not having a UI intervention, the median (IQR) post-prostatectomy UI score was 79.3 (62.5,100.0). This group included 53 men with post-prostatectomy UI scores ≤29.0.

CONCLUSIONS: A total of 48 out of 2965 men underwent an intervention for UI; significant improvements in UI were noted in those for whom data were available. Using the EPIC 26, we identified a similar number of patients (53) who had comparable post-prostatectomy UI scores but did not receive a UI intervention. Although UI interventions were associated with improvements in UI scores, UI scores for those receiving interventions remained poor relative to the large percentage of men for whom, presumably, such interventions were not needed. Clearly, considerable opportunity exists to improve continence rates in all cohorts. EPIC 26 UI scores may help clinicians identify patients who may benefit from UI interventions after radical prostatectomy.

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