Urologists Self-Report Rates of Postprostatectomy Incontinence and Referral Patterns for Treatment

Rates of incontinence after prostate treatment, more specifically postprostatectomy incontinence (PPI), in patients who undergo radical prostatectomy (RP) are highly variable. Appropriate management is contingent on the surgeon's perception of necessity. There is no published literature regarding how surgeons perceive their own PPI rates.

A 22-question survey hosted by Google Forms was developed to query RP surgeon perceptions, demographics, practice patterns, operative techniques, and outcomes and disseminated through social media, alumni mailing lists, and word of mouth.

Ninety-three responses were included. Most (74%) did not perform anti-incontinence procedures and refer < 6% for surgical evaluation. A greater proportion (62%) of RP surgeons refer at least 50% of their patients with bothersome PPI to pelvic floor physical therapy (PFPT). A higher perceived bothersome PPI rate correlated with lower rates of referral to other urologists and lower referral rates to PFPT. Many urologists referred to fellowship-trained PPI surgeons (83%). The most important factors associated with referral were number of pads (83%), perceived favorable outcomes (80%), and comfort with the other urologist (66%).

RP surgeons contribute to the undertreatment of PPI and perceived their PPI rates at levels less than published literature. Most RP surgeons do not perform PPI procedures. They refer less than 10% of bothered patients for surgical evaluation and less than half of bothered patients for PFPT. Strategies to address surgeon-specific factors that contribute to this problem include surgeon recognition of the issue, education on guideline recommendations, standardizing reports of bother, access to trained surgeons who can perform anti-incontinence procedures, and access to PFPT.