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Urinary Incontinence Following Prostate Brachytherapy.

Michael S Leapman1, Nelson N Stone2, Stephen Mock3

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Urinary incontinence (UI) affects 4.4% of men after prostate brachytherapy, often presenting as urge incontinence. Specific risk factors for stress (SUI) and urge (UUI) incontinence differ, impacting quality of life.

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Area of Science:

  • Urology
  • Radiation Oncology

Background:

  • Prostate brachytherapy is a common treatment for localized prostate cancer.
  • Urinary incontinence (UI) is a potential complication following radiation therapy for prostate cancer.
  • Understanding the incidence, timing, and risk factors for UI is crucial for patient counseling and management.

Purpose of the Study:

  • To determine the incidence, time course, and risk factors for developing urinary incontinence (UI) after prostate brachytherapy.
  • To differentiate risk factors for stress UI (SUI) and urge UI (UUI).
  • To assess the impact of UI on quality of life.

Main Methods:

  • A retrospective analysis of 2461 men who underwent prostate brachytherapy.
  • Assessment of clinical and treatment variables associated with UI onset (defined as pad usage).
  • Use of univariate and Cox proportional hazards regression models; evaluation of International Prostate Symptom Score (IPSS) and quality of life (QOL) changes.

Main Results:

  • UI developed in 4.4% of patients at a median of 1.8 years post-treatment.
  • Urge-predominant UI (UUI) was more common (78 cases) than stress UI (SUI) (30 cases).
  • Significant risk factors for SUI included post-implantation transurethral resection of the prostate (TURP), urinary retention, external beam radiation therapy (EBRT), and higher pretreatment IPSS; TURP was the only significant independent risk factor for SUI.

Conclusions:

  • Urinary incontinence occurs in 4.4% of men following prostate brachytherapy, predominantly urge-predominant.
  • Distinct risk factors are associated with the development of UUI versus SUI.
  • UI requiring pad usage significantly impacts urinary quality of life.