INCIDENCE OF FECAL AND URINARY-INCONTINENCE FOLLOWING RADICAL PERINEAL AND RETROPUBIC PROSTATECTOMY IN A NATIONAL-POPULATION

Purpose: Since 1991 we have performed more than 300 anatomical radical perineal prostatectomies at Brooke Army and Wilford Hall Medical Cent ers, and were initially aware of 8 patients who presented with unsolic ited postoperative fecal incontinence. We determined the incidence of fecal and urinary incontinence following radical prostatectomy, define d parameters to identify patients at risk for fecal complaints followi ng radical prostatectomy, and estimated the impact of fecal incontinen ce on lifestyle and activities. Materials and Methods: Initially a val idated 26-question telephone survey was used to evaluate 227 patients who had previously undergone radical prostatectomy at 1 of our 2 insti tutions. Based on results of the telephone survey a national survey wa s mailed to 1,200 radical prostatectomy patients randomly selected fro m a nationwide database of Department of Defense health care system be neficiaries. All patients had undergone radical perineal or retropubic prostatectomy at least 12 months before being contacted for the surve y. Results: Responses to the telephone survey from 227 patients reveal ed that fecal incontinence was a problem after radical retropubic (5%) and perineal (18%) prostatectomy and less than 50% of those with feca l incontinence had told the physician. Our mail survey (response rate 80% and 78% usable for analysis, 784 radical perineal and 123 perineal ) strongly indicated that fecal incontinence after radical prostatecto my is a problem nationwide. Frequency of fecal incontinence (daily, we ekly, monthly or less than monthly occurrences) was significantly high er among radical perineal (3, 9, 3 and 16%) compared to retropubic pro statectomy (2, 5, 3, and 8%) patients (p = 0.002). Fecal incontinence had a significant negative effect on patient social or entertainment a ctivities (p = 0.029), and travel and vacation plans (p = 0.043). Radi cal perineal compared to retropubic prostatectomy patients were more l ikely to wear a pad for stool leakage (p = 0.013), experienced more ac cidents (p = 0.001), had larger amounts of stool leakage (p = 0.002) a nd had less formed stools (p = 0.001). Of radical perineal prostatecto my patients only 14% and of retropubic only 7% with fecal incontinence had ever told a health care provider about it, even when the incontin ence was severe. Responses to our survey concerning urinary incontinen ce showed that radical perineal prostatectomy patients had a lower rat e of urinary incontinence immediately after prostatectomy compared to retropubic (79 versus 85%, p = 0.043). A higher proportion of perineal patients reported that all urinary leakage had ceased, that is full c ontinence had returned (perineal 70%, retropubic 53%, p = 0.001). A sm aller proportion of perineal patients found it necessary to wear a pad to protect from urinary incontinence (perineal 39%, retropubic 56%, p = 0.004). Conclusions: Fecal incontinence following radical prostatec tomy occurs more frequently than previously recognized. In general fec al incontinence among radical perineal and retropubic prostatectomy pa tients surpasses the expected incidence rate of 4% for this age group (60 to 70 years) but incidence is significantly higher for radical per ineal prostatectomy patients. However, radical perineal prostatectomy patients have a significantly lower incidence of urinary incontinence than those treated with retropubic prostatectomy. Surgeons who perform radical retropubic and perineal prostatectomy should be aware of the possibility of fecal and/or urinary incontinence and associated sympto ms.