Utilization of Incontinence Procedures Following Prostate Cancer Treatment: A Population-Level Analysis

Many experience incontinence following prostate cancer treatment. Patients suffering from stress incontinence may benefit from an artificial urinary sphincter (AUS) or urethral sling, however, rates of these procedures following radical prostatectomy (RP) and radiotherapy (RT) are not well-defined. We aimed to assess rates of post-RP and post-RT utilization of AUS and urethral sling in a contemporary, national cohort from the large, federated database TriNetX.

We retrospectively assessed men ≥ 18 years old who were diagnosed with prostate cancer and eventually treated with RP or RT between 2005 and 2015 on TriNetX. Patients with any prior history of AUS or sling before prostate cancer treatment were excluded. Primary outcomes of interest were rates of AUS and sling utilization 6 months to 10 years after RP, RT, or both. We secondarily assessed rates of cystourethroscopy before incontinence procedure and patient factors associated with utilization of AUS or sling.

Between 2005 and 2015, 13 392, 24 173, and 2353 prostate cancer patients were treated with RP, RT, or both treatments, respectively. After RP, within 6 months to 10 years, 244 patients (1.82%) underwent AUS implantation and 234 patients (1.75%) underwent sling placement, compared to 84 patients (0.35%) undergoing AUS implantation and 13 patients (0.05%) undergoing sling placement after RT. Of patients treated with both, 87 (3.70%) patients underwent AUS implantation and 26 (1.10%) underwent sling placement. One-half to three-fourths of these patients underwent cystourethroscopy before AUS/sling placement. RP, receiving care at an academic center, and being 45-69 years old compared to 70+ years old at prostate cancer treatment were significantly associated with AUS/sling utilization. Rates of utilization also varied across race/ethnicity.

AUS and urethral sling utilization amongst post-RP and post-RT prostate cancer survivors is low and variation in utilization exists based on patient characteristics. Our study emphasizes the importance of awareness of guidelines on incontinence after prostate treatment.