Incontinence after laparoscopic radical prostatectomy: a reverse systematic review

Abstract

Purpose: To report the prevalence of the defi nitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria. Materials and Methods: In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence defi nition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP. Results: We identifi ed 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and fi nally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically signifi cant difference between continence criteria was identifi ed only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported. Conclusion: RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.

Assessment of different continence definitions in the context of the randomized multicenter prospective LAP-01 trial—Does the best definition change over time?

“…To date, the most frequently utilized method for continence assessment in RP patients is the number of pads used in a 24-h period, as it is easily accessible, objective and reliable in an ambulatory context [ 6 , 9 , 16 , 25 , 26 ]. However, there is little agreement on how this criterion should be applied.…”

“…Another influencing factor could be the different level of physical activity at 3 months compared to 12 months post-surgery. Since PPI rates are subject to change within the first months before reaching a plateau after approximately a year [ 12 , 25 ], we consider our 12-month evaluation the most relevant in terms of establishing a standardized continence definition. We identified 0 pads as the superior definition at this point in time.…”

“…We therefore assume that a detailed assessment via ICIQ-SF is reasonable in the beginning, but a simple and strict criterion is needed in the long term. The ICIQ-SF is excellent at detecting mild UI, which Azal et al and Mata et al believe to be the main source of discrepancies between ICIQ-SF results and number of pads used [ 25 , 30 ]. Patients with slight leakage tend to not using any pads, possibly because they do not consider their UI as severe [ 25 , 30 ].…”

“…The ICIQ-SF is excellent at detecting mild UI, which Azal et al and Mata et al believe to be the main source of discrepancies between ICIQ-SF results and number of pads used [ 25 , 30 ]. Patients with slight leakage tend to not using any pads, possibly because they do not consider their UI as severe [ 25 , 30 ]. Interestingly, in our study, 44% of the patients who felt subjectively continent at 3 months also reported leakage (cf.…”

Predictors of Urinary Continence Recovery after Laparoscopic-Assisted Radical Prostatectomy: Is Surgical Urethral Length the Only Key Factor?

“…Consequently, ICS's reported values range between 1% and 49% for male UI. Among these patients, 40%-80% suffered from emergency UI, 10-30% were affected by a mixed male UI, and 10-15% were afflicted by male stress UI and, in this context, patients who underwent radical prostatectomy (RP) represented the prevalent part [2]. Since the prevalence of PCa among men and the high amount of RP due to an effective PCa-prevention, UI after prostate radical surgery described an actual problem impacting QoL.…”