RISK-FACTORS FOR URINARY-INCONTINENCE AFTER RADICAL PROSTATECTOMY

Purpose: We identified risk factors associated with urinary incontinen ce after radical retropubic prostatectomy. Materials and Methods: The time from operation until urinary continence was achieved was determin ed by chart review and questionnaire in 581 patients who were continen t before undergoing radical retropubic prostatectomy between 1983 and 1994. Using univariate and multivariate analyses of data gathered pros pectively, we examined risk factors associated with incontinence in th ese patients.Results: The actuarial rate of urinary continence at 24 m onths was 91% for the entire patient population and 95% for those trea ted after 1990. Many factors were associated with the risk of incontin ence in univariate Cox proportional hazards regression analysis (patie nt age and weight, degree of obstructive voiding symptoms, prior trans urethral resection of the prostate, clinical stage, intraoperative blo od loss, resection of neurovascular bundles, postoperative anastomotic stricture and technique of vesicourethral anastomosis). However, in a multivariate analysis the factors that were independently associated with increased chance of regaining continence were decreasing age, a m odification in the technique of anastomosis (introduced in 1990), pres ervation of both neurovascular bundles and absence of an anastomotic s tricture. With introduction of the new surgical technique in 1990 the median time to continence decreased from 5.6 to 1.5 months and the rat e of continence at 24 months increased from 82 to 95%. Conclusions: Wh ile the risk of urinary incontinence after radical prostatectomy is re lated to the uncontrollable factor of patient age, it is also sensitiv e to the surgical technique used.