Cath Lab Digest

Index: Ostomy Wound Manage 2001;47(12):20–25

  Among the many men who Henry David Thoreau said, “lead lives of quiet desperation,” the increasing number of American men suffering from urinary incontinence post prostate cancer surgery undoubtedly could be counted. By their own accounts and those of their families and loved ones, these men, already reeling from a personal confrontation with their own mortality and anguished by erectile dysfunction, are forced to engage in a continual daily struggle to maintain urinary continence – a struggle that includes managing and/or concealing their urinary incontinence from others.

  This paper reviews the prevalence and incidence of urinary incontinence post prostate cancer surgery and discusses risk factors for post-prostatectomy urinary incontinence. Informational and educational strategies available to men and their caregivers also will be discussed.

Epidemiology

  The prevalence and incidence of and risk factors for post-prostatectomy urinary incontinence reveal the magnitude of the problem and offer an understanding of factors that place groups within a population at risk. Prevalence and incidence are rates or proportions. Prevalence refers to the portion of a population or group with a specific condition during a specified time interval. Prevalence includes both new and old cases of incontinence; therefore, the numerator is the number of incontinent men during a time frame (such as 1 year) divided by the number of men in the group. The majority of studies address prevalence, as it provides a gauge for resource allocation – highly prevalent conditions may require frequent access to healthcare providers, medications, treatment, and medical equipment and supplies.

  Incidence refers to new cases that developed during a specific period of time. The denominator includes only those at risk of developing the condition; therefore, only continent individuals are included. The numerator captures the number of men who became incontinent during a specific time frame (ie, 3 months or 1 year). Knowledge of the pre-existing condition allows researchers to identify factors that placed the person at risk for becoming incontinent. In turn, identifying risk factors helps clinicians to devise educational and clinical strategies to prevent new cases of incontinence and, perhaps, to reverse prevalent cases.

  Measurement issues become paramount when trying to determine prevalence and incidence of incontinence. For example, what constitutes a case? Incontinence in some studies was defined as the need to wear pads, and in other studies it was defined as any leakage of urine.^1–6 Some studies do not provide a definition for incontinence.^7-11 The time interval between surgery and measurement of prevalence also varies in studies. Few studies investigated continence at 1 month post surgery; however, in one study undertaken at that interval, prevalence of urinary incontinence was as high as 87%.¹ Prevalence rates at 1 year or more since surgery range from 7% to 85%.

  The person or method of reporting incontinence also can influence prevalence. For example, Wei and Montie¹² compared the agreement between physicians and their patients. The patients were asked to complete a questionnaire about presence of leakage, frequency of incontinent episodes, use of pads for incontinence, and inconvenience of incontinence. Physicians who were blinded to their patients’ responses were asked to assess incontinence and record it in the medical record. When using any leakage as the definition of incontinence, only 23% agreement occurred between physicians and patients. When using number of pads used a day, agreement increased to 67%.