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Post-PVP urinary incontinence associated with age, prostate size

Findings may help clinicians counsel patients, evaluate treatment options


San Francisco—In the minority of patients who experience postoperative urinary incontinence following photoselective vaporization of the prostate for BPH, the more severe symptoms are associated with age and preoperative prostate size, researchers from the University of Michigan, Ann Arbor, reported at the AUA annual meeting.

Forty percent of patients undergoing PVP for BPH had mild urinary incontinence postoperatively, but only half of those patients reported some bother related to the symptoms, according to the researchers.

Incontinence was measured using the Incontinence Symptom Index (ISI) developed by senior author John Wei, MD, professor of urology at the University of Michigan. Importantly, the researchers used a low threshold for the ISI scores, said first author Nina Casanova, MD, a urology resident at Michigan. They wanted to make sure to capture even the most minor incontinence, which meant that many patients scored positive for incontinence but were not troubled by the symptoms.

"We used a score of 4, which is very low," Dr. Casanova told Urology Times. "Some patients were leaking a little, but they were not terribly bothered by these symptoms."

'Significant improvements' with PVP

Overall, patients undergoing PVP for BPH had significant improvements in International Prostate Symptom Score (IPSS) and IPSS "bother" score, which quantify what the patient feels is a problem, she said. The researchers wanted to look at incontinence, as not much is known about it in men treated for BPH, she added.

For the study, the researchers reviewed the charts of 343 patients who had PVP using the GreenLight laser system (American Medical Systems, Minnetonka, MN). The mean age of the patients was 68 years, and there was an average of 32 months follow-up.

Seventy-nine percent of patients experienced a significant improvement in lower urinary tract symptoms, and 41% had significant improvement in quality of life. Postoperatively, there was mild urinary incontinence in 40% of patients, but only half of those patients had symptoms that were bothersome. The two main factors independently associated with postoperative incontinence were age and preoperative prostate size. Noting that the data are preliminary, Dr. Casanova said her team would like to have a better sense of how many men have at least some incontinence after PVP and what type of incontinence can be expected postoperatively.

Thus far, their data suggest that the majority of patients experiencing at least some incontinence post-PVP are having symptoms of urge incontinence, but stress incontinence is also seen.

Knowing that the main factors in postoperative incontinence are age and preoperative prostate size can help physicians discuss options with patients, Dr. Casanova said.

"We're hoping this will help us counsel patients about what they can expect postoperatively," she said. "If it's urge incontinence and only mildly bothersome, an anticholinergic may be helpful. If it's stress, which can occur in older men with pelvic floor issues, they might benefit from pelvic floor therapy prior to surgery."

Dr. Wei serves as a consultant/adviser to American Medical Systems.

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