Urinary incontinence after radical prostatectomy in Germany: real-world results of a large rehabilitation center in 2016 and 2022

Abstract

Introduction: Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role. Aim of the study was to present current real-world data on incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016. Material and Methods: Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 at admission and discharge. Incontinence defined as ≥1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Results: Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in postoperative incontinence rates in 2016 and 2022 were noted at discharge (76.9 vs. 77.9%, p=0.56). A notable increase in patients with Gleason score 3+4 and a shift towards robotic surgery were observed in 2022. While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in incontinence rates. Comparing age groups within the cohort, patients >69 years exhibited the highest risk of postoperative incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p<0.01) lower incontinence rates. Conclusion: Our study shows little improvement in short term post-operative incontinence rates after radical prostatectomy in Germany in the last six years and known risk factors for post-operative incontinence like age, nerve-sparing surgery and level of experience were reproduced in our analyses. We conclude to carefully select patients for RP and to strongly advice treatment at certified centers.