A prospective study of patient reported urinary incontinence among American, Norwegian and Spanish men 1 year after prostatectomy

Abstract Objective Few studieshave assessed the inter-country prevalencesof urinary incontinence after radical prostatectomy (RP) based on prospectively collected data on patient-reported outcome measures.We comparedpre-and post-RP responses in the urinary incontinence domain of Expanded Prostate Cancer Index Composite-26 (EPIC-26) in cohorts from the USA, Norway and Spain. Methods A prospective study of pre- and 1- year post-treatment responses in American (n = 537), Norwegian (n = 520) and Spanish (n = 111) patients, establishing the prevalence of urinary incontinence defined according to published dichotomization. Thereafter we focused onthe response alternatives “occasional dribbling”, pad use and problem experience.A multivariate logistic regression analysis (significance level ≤0.01) considered risk factors for “not retaining total control”. Results Compared to the European men, the American patients were younger, healthier and more presented with lower risk tumors. Before RP no inter-country differences emerged the prevalence of urinary incontinence (6%). One-year post-treatment urinary incontinence was described by 30% of the American and 41% of the European patients, occasional dribbling being the most frequent type of urinary leakage. In the multivariate analysis the risk of “not retaining total control” increased almost 3-fold in European compared to American patients, with age and co-morbidity being additional independent risk factor. Conclusion After RP patients from Spain and Norway reported more unfavorable outcomes by EPIC-26 than the American patients to most of the urinary incontinence items, the difference between the European and American patients remaining in the multivariate analysis. The most frequent post-RP response alternative “occasional dribbling” needs to be validated with pad weighing as “gold standard”.