Prospective assessment of patient reported urinary continence after radical prostatectomy

Purpose: Reported urinary continence rates after radical prostatectomy vary . Although modifications of radical prostatectomy meant to improve outcome, such as nerve sparing or bladder neck preservation, are in widespread use, to our knowledge evidence to support these practices based on patient repo rt is scant. We evaluated the potential effects of nerve sparing and bladde r neck preservation on urinary continence after radical prostatectomy, and assessed the impact of various urinary continence definitions on the observ ed outcome. Materials and Methods: We prospectively evaluated a cohort of men with pros tate cancer who elected surgery with and without nerve sparing, and bladder neck preservation as primary therapy. A total of 482 men completed a brief urinary continence questionnaire preoperatively and postoperatively at a m edian followup of 18 months. Urinary continence was followed prospectively using the questionnaire and patient reported urinary continence recovery wa s based on 3 definitions of continence. Results: Median time to continence recovery based on patient reporting was significantly shorter in the nerve sparing than in the nonnerve sparing gro up when continence was defined as no urinary leakage (5.3 versus 10.9 month s, p <0.01). A multivariate model controlling for baseline factors revealed that significant predictors of continence outcome were preoperative contin ence, patient age, nerve sparing and the interaction of nerve sparing with age (p <0.05). The definition of urinary continence also affected outcome. Conclusions: The nerve sparing technique of radical prostatectomy was assoc iated with improved recovery of urinary continence in an age dependent mann er, whereas bladder neck preservation was not beneficial. Patient age and t he sensitivity of the incontinence definitions, as reflected by the associa ted variable rates of preoperative baseline incontinence, are significant c ontexts for interpreting urinary function data after radical prostatectomy. These factors may partially explain the variation in continence rates in t he literature.