Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis

To assess prospectively-using pad test and questionnaire-the rate and degree of incontinence after radical retropubic prostatectomy, to analyze factors that may predispose individuals to postoperative incontinence, and to assess the impact of incontinence on patient lifestyle.

Fifty-one consecutive patients were assessed at 3-month intervals for 1 year after radical retropubic prostatectomy. Patients were objectively assessed using a 1-hour pad test and subjectively assessed by questionnaire. Incontinence was graded objectively according to the change in weight of the pad at 1 hour and subjectively by the number of pads used per day. Lifestyle modifications were assessed by questionnaire at 12 months. A number of variable factors were studied to assess risk factors for postoperative incontinence.

Continence continued to improve up to 12 months. At 12 months, pad testing revealed 84% of patients were dry, 6% were mildly incontinent. 6% were moderately incontinent, and 4% were severely incontinent. Questionnaire assessment revealed 80% wore no pad, 14% had mild incontinence, 4% had moderate incontinence, and 2% had severe incontinence. Pad testing was not as sensitive as the questionnaire for the detection of minimal incontinence but was more reliable for moderate and severe levels. Patients made lifestyle changes proportional to the level of incontinence. No predisposing factor was identified for the development of incontinence after radical retropubic prostatectomy.

Significant incontinence after radical prostatectomy occurs in as many as 10% of patients. Pad testing provides an inexpensive and simple form of objective assessment in patients with bothersome incontinence and allows documentation of improvement over time.