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| A prospective study of patient reported urinary incontinence among American, Norwegian and Spanish men 1 year after prostatectomy |
Anne Holck Storåsa,*( ),Martin G. Sandab,Olatz Garinc,Peter Changd,Dattatraya Patile,Catrina Crocianid,Jose Francisco Suarezf,Milada Cvancarovaa,Jon Håvard Logea,g,Sophie D. Fossåa,g
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a Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
b Department of Urology, Emory University Hospital, Atlanta, USA
c IMIM Hospital del Mar Medical Research Institute, CIBER en Epidemiología y Salud Pública, CIBERESP, Universitat Pompeu Fabra, Barcelona, Spain
d Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
e Emory University Hospital, Atlanta, USA
f Hospital Universitary de Bellvitge, Barcelona, Spain
g University of Oslo, Oslo, Norway |
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Abstract Objective: To compare pre- and post-radical prostatectomy (RP) responses in the urinary incontinence domain of Expanded Prostate Cancer Index Composite-26 (EPIC-26) in cohorts from the USA, Norway and Spain.
Methods: A prospective study of pre- and 1-year post-treatment responses in American (n=537), Norwegian (n=520) and Spanish (n=111) patients, establishing the prevalence of urinary incontinence defined according to published dichotomization. Thereafter we focused on the response alternatives “occasional dribbling”, pad use and problem experience. A multivariate logistic regression analysis (significance level ≤ 0.01) considered risk factors for “not retaining total control”.
Results: Compared to the European men, the American patients were younger, healthier and more presented with lower risk tumors. Before RP no inter-country differences emerged the prevalence of urinary incontinence (6%). One-year post-treatment urinary incontinence was described by 30% of the American and 41% of the European patients, occasional dribbling being the most frequent type of urinary leakage. In the multivariate analysis the risk of “not retaining total control” increased almost 3-fold in European compared to American patients, with age and co-morbidity being additional independent risk factor.
Conclusion: After RP patients from Spain and Norway reported more unfavorable outcomes by EPIC-26 than the American patients to most of the urinary incontinence items, the difference between the European and American patients remaining in the multivariate analysis. The most frequent post-RP response alternative “occasional dribbling” needs to be validated with pad weighing as “gold standard”.
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Received: 05 February 2018
Available online: 19 August 2019
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Corresponding Authors:
Anne Holck Storås
E-mail: annhol@ous-hf.no
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| Variable, n (%) | USA | Norway | Spain | p-Value | Total | | (n=537) | (n=520) | (n=111) | Norway vs. USA | USA vs. Spain | Norway vs. Spain | (n=1168) | | Age, n (%) | | <65 year | 406 (76) | 318 (61) | 57 (51) | <0.01 | <0.01 | n.s. | 781 (67) | | Median age, year | 59.9 | 63.5 | 64.7 | 62.3 | | No co-morbid condition, n (%) | 459 (86) | 369 (71) | 73 (66) | <0.01 | <0.01 | <0.01 | 901 (77) | | Living together, n (%) | 468 (87) | 486 (94) | 100 (90) | <0.01 | n.s | n.s | 1 054 (90) | | Education above high school level, n (%) | 459 (86) | 268 (52) | 8 (7) | <0.01 | <0.01 | <0.01 | 735 (63) | | PSA mean, SD | 6.6 (0.5-54) | 9.9 (1.6-75) | 7.9 (3.8-23) | <0.01 | <0.01 | <0.01 | 8.0 (0.5-75) | | Gleason score, n (%) a | | ≤6 | 331 (62) | 245 (47) | 63 (57) | <0.01 | <0.01 | n.s | 639 (55) | | 7 | 181 (34) | 228 (44) | 44 (40) | | | | 453 (40) | | ≥8 | 25 (5) | 47 (9) | 3 (3) | | | | 75 (6) | | T category, n (%) | | T1 | 388 (72) | 323 (62) | 72 (65) | <0.01 | n.s. | n.s. | 783 (67) | | T2a | 116 (22) | 119 (23) | 32 (29) | | | | 267 (23) | | T2b | 20 (4) | 44 (8) | 7 (6) | | | | 71 (6) | | T2c | 13 (2) | 34 (7) | 0 (0) | | | | 47 (4) | | Risk group, n (%) b | | Low | 289 (54) | 162 (31) | 45 (41) | ≤0.01 | ≤0.01 | ≤0.01 | 496 (43) | | Intermediate | 215 (40) | 293 (56) | 62 (56) | 570 (49) | | High | 33 (6) | 65 (13) | 4 (4) | 102 (9) | | Nerve-sparing, n (%) c | | Bilateral | 429 (80) | 235 (45) | 23 (21) | <0.01 | <0.01 | <0.01 | 687 (59) | | Unilateral | 62 (12) | 141 (27) | 5 (5) | | | | 208 (18) | | No | 45 (8) | 144 (28) | 80 (72) | | | | 269 (23) | | Patients with “good erectile function” pre-treatment (yes/all valid answers), n (%) | 434/522 (83) | 363/496 (73) | 64/111 (58) | <0.01 | <0.01 | <0.01 | 861 (76) |
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Patient characteristics.
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| EPIC-26 item, n (%) | Pre-treatment | One year post-treatment | | USA (n=537) | Norway (n=520) | Spain (n=111) | p-Value | USA (n=537) | Norway (n=520) | Spain (n=111) | p-Value | | Leakage >1 per day | 22 (4) | 15 (3) | 6 (5) | n.s | 84 (16) | 136 (26) | 17 (15) | <0.01b | | Frequent dribbling/no urinary control | 11 (2) | 5 (1) | 4 (4) | n.s | 21 (4) | 41 (8) | 28 (25) | <0.01b,c,d | | Pad use ≥1 per day | 5 (1) | 8 (2) | 1 (1) | n.s | 126 (24) | 202 (39) | 42 (38) | <0.01b,c | | Moderate or big leaking problem | 7 (1) | 12 (2) | 4 (4) | n.s | 42 (8) | 100 (20) | 30 (27) | <0.01b,c | | Incontinencea | 36 (7) | 22 (4) | 8 (7) | n.s | 160 (30) | 216 (41) | 48 (42) | <0.01b,c |
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Dichotomized responses of the items in the urinary incontinence domain, pre-treatment and post-treatment.
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Change in urinary control from pre-treatment to 1 year postoperative. (Steps of item 2 of EPIC-26: Total control-occasional dribbling-frequent dribbling-no urinary control). EPIC, expanded prostate cancer index composite-26.
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Functional level, pad use and urinary problem 1 year after RP among 891 patients with total control pre-treatment. RP, radical prostatectomy; Freq, frequent.
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| Bivariate | Multivariate | | OR (95% CI) | p-Value | OR (95% CI) | p-Value | | Age | | ≥65 year | 1.6 (1.2-2.1) | <0.01 | 1.3 (1.0-1.8) | 0.09 | | <65 year | 1 | 1 | | Co-morbidity, | | ≥1 co-morbidity | 1.9 (1.4-2.7) | <0.01 | 1.6 (1.1-2.2) | 0.01 | | No | 1 | 1 | | Risk group | | Intermediate | 1.2 (0.9-1.6) | 0.18 | 1.3 (0.7-1.3) | 0.3 | | High | 1.8 (1.1-2.9) | 0.03 | 0.9 (0.6-1.2) | 0.3 | | Low | 1 | | 1 | | | Nerve sparing | | No | 1.9 (1.4-2.6) | <0.01 | 1.1 (0.8-1.6) | 0.6 | | Unilateral | 1.5 (1.1-2.1) | 0.02 | 1.1 (0.7-1.7) | 0.6 | | Bilateral | 1 | | 1 | | | Site | | Europe (Spain and Norway) | 2.7 (2.0-3.6) | | 2.7 (2.0-3.7) | <0.01 | | USA | 1 | <0.01 | 1 | |
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OR, 95% CI of not retaining “total control” 1 year post-treatment, bivariate and multivariate analysis. Only patients with “total control” pre-treatment were included.
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