Daily Pad Usage Versus the International Consultation on Incontinence Questionnaire Short Form for Continence Assessment Following Radical Prostatectomy

Abstract

Purpose: Continence assessment is an essential component of follow-up after radical prostatectomy (RP). Several methods exist to assess the severity of urinary incontinence (UI). Our study examined the relationship and degree of agreement between International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and the number of pads used in a 24-hour period in the assessment of UI following RP.Methods: Continence was prospectively assessed in 746 men from a Spanish urology clinic 12 months after RP using the ICIQ-SF and pad usage. The relationship between ICIQ-SF scores and pad usage was assessed using Spearman rank correlation coefficients. The Jonckheere-Terpstra trend test was used to determine whether the ICIQ-SF score and the component question scores increased with increasing pad usage. The Bonferroni-corrected pairwise Wilcoxon rank-sum test was used to determine which pairs of pad usage levels differed. The weighted kappa was used to evaluate the agreement between pad usage levels and ICIQ-SF questions.Results: The continence rate was 82% using the “no pad usage” definition of continence versus 78% using the definition of an ICIQ-SF score of 0 (P<0.001). Strong positive correlations were observed between the number of pads and the ICIQ-SF total and component question scores (r<sub>s</sub>>0.85, P<0.001). The ICIQ-SF total and component question scores increased significantly with increasing pad usage (P<0.001). The ICIQ-SF scores (P<0.018) for all pairs of pad usage levels (0, 1, 2, or 3 or more) differed significantly. The agreement between the ICIQ-SF leakage amount question and pad usage was very good (r<sub>s</sub>=0.861, P<0.001).Conclusions: At 12 months post-RP, 24-hour pad usage was closely correlated with ICIQ-SF, although the continence rate differed depending on the definition used. Higher levels of pad usage were associated with higher questionnaire scores, more leakage, and poor quality of life (interference with everyday life).

What is the impact of post‐radical prostatectomy urinary incontinence on everyday quality of life? Linking Pad usage and International Consultation on Incontinence Questionnaire Short‐Form (ICIQ‐SF) for a COMBined definition (PICOMB definition)

“…It has good internal consistency and strong correlation with pad usage, aspects also demonstrated in our study (Cronbach's α = 0.815; and Spearman's ρ > 0.65 between the different items of ICIQ‐SF and pad usage) 10 . Some studies have observed a good or excellent concordance between ICIQ‐SF and pad usage 21 . This degree of concordance is not found in our study and is only acceptable when using the definition of 0 pads (Cohen's κ = 0.466) and is made worse by adopting less strict definitions 22 …”

“…10 Some studies have observed a good or excellent concordance between ICIQ-SF and pad usage. 21 This degree of concordance is not found in our study and is only acceptable when using the definition of 0 pads (Cohen's κ = 0.466) and is made worse by adopting less strict definitions. 22 When assessing the deficit in QoL secondary to urinary leakage, we were unable to identify significant differences between patients with an ICIQ score = 0 and patients with an ICIQ score = 2, that is, there is no evidence that patients who never leak urine have a higher QoL than patients who leak "a small amount" of urine "about once a week."…”

Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy

“…A broadly accepted conservative definition of urinary continence after radical prostatectomy has been pad-free status (no pad use per 24 h in the past week) 91 , 203 . Alternative definitions of continence include ‘social continence’ where pad use is ≤1 pad per day 91 , 108 .…”

“…The evaluation of urinary function directly by clinicians is often inadequate 204 , requiring the use of validated questionnaires to obtain patient-reported outcome measures 205 . Validated questionnaires, such as the International Consultation on Incontinence Questionnaire (ICIQ) on Male Lower Urinary Tract Symptoms (ICIQ‐MLUTS) 206 , 207 , a short form thereof (ICIQ-SF) 49 , 203 , 208 , the Expanded Prostate Cancer Index Composite (EPIC) 205 , 209 urinary incontinence domain and the University of California Los Angeles Prostate Cancer Index (UCLA-PCI), have been used 210 .…”

The Effectiveness of Pelvic Floor Muscle Training in Men after Radical Prostatectomy Measured with the Insert Test

“…Some researchers believe that the criterion for full continence control is the lack of pads for 24 h in the last week. Other researchers believe that ≤1 pad per day means “social continence” [ 19 , 20 , 21 ]. Regardless of the adopted criteria, researchers report that UI may affect up to 80% of patients after RP [ 22 ].…”