Stephen Mock

Risk of urinary incontinence following post-brachytherapy transurethral resection of the prostate and correlation with clinical and treatment parameters.

PURPOSE We assess the risk of urinary incontinence after transurethral prostate resection in patients previously treated with prostate brachytherapy. MATERIALS AND METHODS A total of 2,495 patients underwent brachytherapy with or without external beam radiation therapy for the diagnosis of prostate cancer between June 1990 and December 2009. Patients who underwent transurethral prostate resection before implantation were excluded from study. Overall 79 patients (3.3%) underwent channel transurethral resection of the prostate due to urinary retention or refractory obstructive urinary symptoms. Correlation analyses were performed using the chi-square (Pearson) test. Estimates for time to urinary incontinence were determined using the Kaplan-Meier method with comparisons using logistic regression and Cox proportional hazard rates. RESULTS Median followup after implantation was 7.2 years. Median time to first transurethral prostate resection after implantation was 14.8 months. Of the 79 patients who underwent transurethral prostate resection after implantation 20 (25.3%) had urinary incontinence compared with 3.1% of those who underwent implantation only (OR 10.4, 95% CI 6-18, p<0.001). Of the 15 patients who required more than 1 transurethral prostate resection, urinary incontinence developed in 8 (53%) compared with 19% of patients who underwent only 1 resection (OR 4.9, 95% CI 1.5-16, p=0.006). Exclusion of patients who underwent multiple transurethral prostate resections still demonstrated significant differences (18.8% vs 3.1%, OR 7.1, 95% CI 3.6-13.9, p<0.001). Median time from last transurethral prostate resection to urinary incontinence was 24 months. On linear regression analysis, hormone use and transurethral prostate resection after implantation were associated with urinary incontinence (p<0.05). There was no correlation between the timing of transurethral prostate resection after implantation and the risk of incontinence. CONCLUSIONS Urinary incontinence developed in 25.3% of patients who underwent transurethral prostate resection after prostate brachytherapy. The risk of urinary incontinence correlates with the number of transurethral prostate resections. Patients should be counseled thoroughly before undergoing transurethral prostate resection after implantation.

Urinary Incontinence Following Prostate Brachytherapy

OBJECTIVE To define the incidence, time course, and risk factors associated with the development of urinary incontinence (UI) following prostate brachytherapy. MATERIALS AND METHODS A total of 2461 men were identified who underwent permanent interstitial prostate brachytherapy with or without external beam radiation therapy. We examined the relationship between clinical- and treatment-related variables with the onset of UI, defined as leakage requiring pad usage, and further classified as stress (SUI) or urge (UUI) predominant, using univariate and Cox proportional hazards regression models. The changes in International Prostate Symptom Score and quality of life domains were assessed from baseline to last follow, and examined by UI status. RESULTS Patients were followed for a median of 6.4 years (interquartile range 4.1-9.3). UI was reported in 108 individuals (4.4%), at a median of 1.8 years (interquartile range 5 months-4.4 years): 30 with SUI and 78 with UUI. Seventy-two men (66.7%) reported using 1, 24 (22.2%) using 2, and 12 (11%) using ≥3 pads per day. On multivariate analysis, post-implantation transurethral resection of the prostate, urinary retention, external beam radiation therapy, and higher pretreatment International Prostate Symptom Score were significantly associated with the development of SUI, although transurethral resection of the prostate was the only significant risk factor associated with SUI. Men experiencing UI reported greater declines in urinary quality of life; however, no significant difference was observed between SUI and UUI. CONCLUSION UI occurred in 4.4% of patients following prostate brachytherapy and is more commonly urge-predominant in character. Distinct risk factors exist for the development of UUI vs SUI. Urinary leakage requiring pad usage was associated with declines in urinary QOL.

1348 IMPACT OF MALE URETHRAL SLING PLACEMENT ON POST-PROSTATECTOMY CLIMACTURIA

INTRODUCTION AND OBJECTIVES: Radical prostatectomy (RP) is an effective treatment for localized prostate cancer, but can result in long term complications such as stress urinary incontinence and erectile dysfunction. Climacturia is a poorly characterized consequence of RP that can have adverse quality of life implications and has been cited to affect up to 93% of post RP patients. The aim of this study is to determine the impact of male urethral sling placement on postprostatectomy climacturia. METHODS: A retrospective review of all men who underwent urethral sling placement between 2007 and 2011 was generated. All patients were queried by telephone questionnaire that examined aspects of climacturia, including frequency, amount of urine loss, bother score of patient and partner, and coping mechanisms (Lee, et al), both before and after urethral sling placement. RESULTS: Thirty-three patients were eligible for analysis. Twenty patients answered the full questionnaire and comprise the study cohort. Pre operative average pad weight was 153 g (range 50-370). Mean follow-up was 18 months (range 3.1-37.8). Sixteen of 20 men (80%) were pad-free or minimally spotting on chart review at last follow-up. Fifteen of 20 men were not sexually active prior to sling placement. Eight were impotent, 1 was celibate and 6 were potent, but avoided sexual activity due to incontinence during intercourse. In total, there were 11 potent men, of which 10 acknowledged climacturia. All of the men and their partners (100%) found climacturia to be bothersome to varying degrees (see Figure). After sling placement, 9 of 10 men (90%) had improvement in bother score for climacturia (p 0.05). Six of 10 men (60%) had completely resolved climacturia, including 3 who avoided sexual activity due to leakage prior to sling placement. In three of the 4 patients who still had climaturia, it rarely occurred and the amount of urine loss was quantified as a few drops. CONCLUSIONS: Male urethral sling placement for post-prostatectomy climacturia has a positive effect, with 90% of the study group showing a benefit. Climacturia should be specifically inquired about in the post-prostatectomy period and if it results in sufficient bother to the patient, urethral sling placement as a treatment should be discussed.