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PD32-04 NATURAL HISTORY OF MODERATE TO SEVERE INCONTINENCE AFTER PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: Post prostatectomy incontinence (PPI) can have a drastic impact on quality of life. In reported literature, the natural history of men with moderate to severe PPI has not been adequately studied. Our aim was to better predict which patients would benefit from prompt surgical interventions for incontinence. We hypothesized that men using >3 pads after surgery would be much less likely to regain continence and would be most bothered by their symptoms. METHODS: The study population included men with localized prostate cancer treated with radical prostatectomy at a single center from December 1999 to April 2018. After IRB approval, EPIC-26 and UCLA quality of life surveys were completed at multiple time points post-op, up to 60-month follow-up. Associations between health outcomes and pad use were assessed using Pearson's chi square tests. Post-surgery improvement in urinary control and quality of life were modeled using multinomial logistic regression. RESULTS: A total of 1,568 patients were assessed at 30 months and 689 at 60 months post-op. At one-month following surgery, 1,034 reported using <3 pads and 534 reported >3 pads. Patients using <3 pads post-surgery were 7.17 times more likely to become continent (0-1 pad) by month 30 compared to patients using >3 pads (95% CI 5.151, 9.991). The probability of a severely incontinent patient regaining continence by month 30 was .12, while those using <3 pads had a .88 probability of obtaining continence. Of those that weren't lost to follow-up, the probability of continence by month 60 remained stable at .13 and .87, for those using >3 and <3 pads respectively. Age was not significantly associated with continence in the >3 pad group. Patients requiring >3 pads reported lower quality of life scores. High bother score at any time post-surgery was significantly associated with using more than 3 pads (p<.0001). Patients using <3 pads were 3.572 times more likely to improve in bother score by month 30 (95% CI 2.734,4.668). The probability of improvement in bother score in a patient who used >3 pads was .22, compared to .78 in patients using <3 pads. CONCLUSIONS: Based on our data, the status of urinary control in the first month following radical prostatectomy, assessed by quantitative pad counts and qualitative reports of symptoms, can predict long term outcomes. Patients requiring >3 pads are less likely to recover continence and continue to report high bother scores long after prostatectomy. This cohort should be appropriately counseled as they may benefit from early surgical interventions for PPI. Source of Funding: None