What's known on the subject? and What does the study add? • Urinary incontinence is one of the most important morbidities after radical prostatectomy that has detrimental effect on the postoperative quality of life. • The present study provides an accurate and dynamic multivariable risk stratification tool that predicts the postoperative urinary incontinence risk after radical prostatectomy based on patient-related as well as surgeon-related variables. Objective: • To develop a multivariable risk classification tool to estimate postoperative urinary incontinence (UI) risk as UI represents one of the most disabling surgical sequelae after radical prostatectomy (RP). Patients and Methods: • We evaluated 1311 patients treated with nerve-sparing RP between 2006 and 2010 at our institution. • Regression tree analysis was used to stratify patients according to their postoperative UI risk. Kaplan-Meier curve estimates were used to assess the UI rate in the novel UI-risk groups. The discrimination of the novel tool was measured with the area under the curve method. Results: • At 3, 6 and 12 months, the UI rates were 44%, 26% and 12%, respectively. Regression tree analysis stratified patients into high risk (International Index of Erectile Function - Erectile Function domain [IIEF-EF] = 1-10), intermediate risk (IIEF-EF > 10 and age ≥ 65 years), low risk (IIEF-EF > 10, age <65 years and body mass index [BMI] ≥ 25 kg/m2) and very low risk (IIEF-EF > 10, age <65 years and BMI <25 kg/m2) groups. • The 3-month UI rates in these groups were 37%, 43%, 45% and 48%, respectively. The 6-month UI rates were 19%, 23%, 29% and 34%, respectively. The 12-month UI rates were 7%, 13%, 14% and 15%, respectively (log-rank P <0.001). • The area under the curve was 71%, 70% and 68% at 3, 6 and 12 months, respectively. Conclusions: • We developed the first risk classification tool that predicts patients at high risk of UI after RP. These consisted mainly of individuals who were impotent before RP, elderly and/or overweight. • This tool can be used for patient counselling.
- prostatectomy/adverse effects
- risk assessment
- survival analysis
- treatment outcome
- urinary incontinence/aetiology
ASJC Scopus subject areas