A continence index predicts the early return of urinary continence after radical retropubic prostatectomy

Purpose: We evaluated the ability of a newly developed continence index to predict the return of urinary continence 3 months after radical retropubic prostatectomy. Materials and Methods: We developed and used a continence index to determin e continence level after removal of the urinary catheter on postoperative d ay 15 in 145 men. A total of 20 patients were evaluated independently by 2 nurse specialists to assess continence index reliability. We evaluated cont inence level, pad use and degree of bothersomeness due to incontinence 3 mo nths after catheter removal. The association of continence score with outco me variables was calculated using the Mantel-Haenszel trend test and the pr edictive ability of the continence score was determined by logistic regress ion to produce cumulative odds ratios. Results: The intraclass correlation coefficient was 0.995 for the independe ntly assessed continence index ratings and the Cronbach coefficient cr was 0.65 for the 5 continence index parameters. Complete continence or continen ce with heavy activity but not always was achieved by 96%, 85% and 68% of t he men in tertiles 1 (continence score 18), 2 (continence score 15 to 17) a nd 3 (continence score 14 or less), respectively. The cumulative odds ratio of 2.9 (95% confidence interval [CI] 1.9 to 4.6) per tertile indicated. a 2.9-fold increased chance of incontinence for each successively lower terti le. In addition, 96%, 82% and 68% of the men in tertiles 1 to 3, respective ly, required no or 1 small pad daily. The cumulative odds ratio for pad use was 2.3 (95% CI 1.5 to 3.5) per tertile. Of the patients in tertiles 1 to 3 100%, 97% and 80%, respectively, had no or slight bothersomeness due to u rinary incontinence. The cumulative odds ratio for bothersomeness level was 2.7 (95% CI 1.7 to 4.3) per tertile. The Mantel-Haenszel trend test showed a significant association of continence score with all 3 outcome variables (p less than or equal to 0.001). Conclusions: Our continence index is a simple and reliable instrument that provides useful prognostic information on the early return of continence af ter radical retropubic prostatectomy.