Finally: The WHOLE Truth About Incontinence After Robot-Assisted Prostate Cancer Surgery

The following excerpts are reposted from The “New” Prostate Cancer InfoLink (prostatecancerinfolink.net)  news blog, with permission of the author.   This piece is a bit dense, so if you want to know the gist of it, read the last two paragraphs.

Just to clarify things, the authors of this study used two criteria to assess urinary function after RALP  (robot-assisted laparascopic prostatectomy) for the treatment of prostate cancer .  One standard is higher than the other:  The first, LFPF, means, “leak free and pad free”.  Of course that is the level of continence that patients desire.  This study found that, at 24 months post-RP,  about one-third of men who were LFPF before surgery achieved this level of continence after RALP.  However, the authors also assessed urinary function after RALP using lesser standards (e.g., allowing for some leakage, the wearing of a pad or a “security pad”).   At 24 months, 68% and 90% of this latter group, respectively, were considered “continent” depending on the definition used.  The authors emphasize that men who were LFPF before surgery had a much higher chance of regaining that status.

NOTE: All italics are *mine*.

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“Strict leak- and pad-free continence after RALP: is this the real truth?”

“‘The issue of complete continence after radical prostatectomy (RP)  is a subject that few in the urologic surgery community have addressed in thorough detail. However, a new article based on data from a single-institution series of patients at the University of Chicago may have finally opened the doors to some honesty about this topic.

“Reynolds and colleagues set out to develop a strict and specific definition of continence — which they characterize as ‘leak-free and pad-free’ or LFPF –- and to apply it to outcomes of patients after robot-assisted radical prostatectomy at their institution.

“Between February 2003 and September 2007, the authors collected reviewable data on pre- and post-surgical continence for 1,005/1,500 patients treated for prostate cancer with RALP at a single institution.  Specific responses to urinary function and continence items were reviewed at baseline (prior to surgery) and at 1, 3, 6, 12, and 24 months after surgery.

“Based on the authors’ strict definition of  LFPF continence, they observed the following:

• Prior to surgery,  73 percent of these patients were LFPF
• The proportion of patients who met LFPF criteria decreased to 4, 9, 17, 24, and 28 percent at 1, 3, 6, 12, and 24 months after surgery, respectively.

[This last sentence, especially the word, "decreased", confused some people, as continence usually improves with time.  So the "decrease" here is *relative* to their LFPF status before surgery.  Even with progress made over 24 months, the percentage of men who were LFPF  after RALP was only 28%]

“When Reynolds et al. applied less strict defiitions of continence:

• At 24 months post surgery,  68 percent of patients  reported no pad use.
• Also at 24 months post-surgery, 90 percent of patients reported no pad use or the use of a security pad.

“Finally, when patients were stratified by their baseline LFPF status:

• Patients who were not LFPF at baseline had higher baseline international prostate symptom scores, lower urinary function scores, lower urinary bother scores, and larger prostate weights.
• Patients who were LFPF at baseline disproportionately regained LFPF continence starting 6 months after surgery compared with those not LFPF at baseline: 20 vs 9 percent at 6 months, 27 vs 15 percent at 12 months, and  33 vs 15 percent at 24 months.

“The authors conclude,  first and foremost, that a strict definition of urinary continence results in more conservative postoperative outcomes.  They go on to state that,  ‘Preoperative LFPF status can be predictive of postoperative LFPF continence.  However, only one-third of patients LFPF at baseline returned to LFPF at 24 months.’  <snip>

“Patients are encouraged,  from now on, to specifically ask their surgeons whether their post-surgical incontinence rates are categorized into those who are LFPF,  pad-free, or wearing security pads at two years post-surgery. We assume that at least some surgeons will be able to improve on the rates published by Reynolds et al.”

http://prostatecancerinfolink.net/2009/11/16/strict-leak-and-pad-free-continence-after-ralp-is-this-the-real-truth/