- Journal
- EUROPEAN UROLOGY FOCUS
- Année
- 2022
- Volume
- 8
- Numéro
- 3
- Pages
- 674-689
- Mois
- MAY
- DOI
- 10.1016/j.euf.2021.04.020
Abstract
Context: While urinary incontinence (UI) commonly occurs after radical prostatectomy (RP), it is unclear what factors increase the risk of UI development.Objective: To perform a systematic review of patient-and tumour-related prognostic factors for post-RP UI. The primary outcome was UI within 3 mo after RP. Secondary outcomes included UI at 3-12 mo and >12 mo after RP.Evidence acquisition: Databases including Medline, EMBASE, and CENTRAL were searched between January 1990 and May 2020. All studies reporting patient-and tumour-related prognostic factors in univariable or multivariable analyses were included. Surgical factors were excluded. Risk of bias (RoB) and confounding assess-ments were performed using the Quality In Prognosis Studies (QUIPS) tool. Random -effects meta-analyses were performed for all prognostic factor, where possible. Evidence synthesis: A total of 119 studies (5 randomised controlled trials, 24 prospective, 88 retrospective, and 2 case-control studies) with 131 379 patients were included. RoB was high for study participation and confounding; moderate to high for statistical analysis, study attrition, and prognostic factor measurement; and low for outcome measurements. Significant prognostic factors for postoperative UI within 3 mo after RP were age (odds ratio [OR] per yearly increase 1.04, 95% confidence interval [CI] 1.03- 1.05), membranous urethral length (MUL; OR per 1-mm increase 0.81, 95% CI 0.74-0.88), prostate volume (PV; OR per 1-ml increase 1.005, 95% CI 1.000-1.011), and Charlson comorbidity index (CCI; OR 1.28, 95% CI 1.09-1.50).Conclusions: Increasing age, shorter MUL, greater PV, and higher CCI are independent prognostic factors for UI within 3 mo after RP, with all except CCI remaining prognostic at 3-12 mo. Patient summary: We reviewed the literature to identify patient and disease factors associated with urinary incontinence after surgery for prostate cancer. We found increasing age, larger prostate volume, shorter length of a section of the urethra (membranous urethra), and lower fitness were associated with worse urinary inconti-nence for the first 3 mo after surgery, with all except lower fitness remaining predictive at 3-12 mo. (c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.