Surgeon volume and patient-reported urinary incontinence after radical prostatectomy. Population-based register study in Sweden

Abstract

Objective

To investigate the association between surgeon volume and urinary incontinence after radical prostatectomy.

Methods

A total of 8326 men in The National Prostate Cancer Register of Sweden (NPCR) underwent robot-assisted radical prostatectomy (RARP) between 2017 and 2019 of whom 56% (4668/8 326) had responded to a questionnaire one year after RARP. The questionnaire included the question: ‘How much urine leakage do you experience?’ with the response alternatives ‘Not at all’, ‘A little’, defined as continence and ‘Moderately’, ‘Much/Very much’ as incontinence. Association between incontinence and mean number of RARPs/year/surgeon was analysed with multivariable logistic regression including age, Charlson Comorbidity Index (CCI), PSA, prostate volume, number of biopsy cores with cancer, cT stage, Gleason score, lymph node dissection, nerve sparing intent and response rate to the questionnaire.

Results

14% (659/4 668) of the men were incontinent one year after RARP. There was no statistically significant association between surgeon volume and incontinence. Older age (>75 years vs. < 65 years, OR 2.29 [95% CI 1.48–3.53]), higher CCI (CCI 2+ vs. CCI 0, OR 1.37 [95% CI 1.04–1.80]) and no nerve sparing intent (no vs. yes OR 1.53 [95% CI 1.26–1.85]) increased risk of incontinence. There were large differences in the proportion of incontinent men between surgeons with similar annual volumes, which remained after adjustment.

Conclusions

The lack of association between surgeon volume and incontinence and the wide range in outcome between surgeons with similar volumes underline the importance of individual feedback to surgeons on functional results.

Keywords:

• Electronic PROM
• patient-reported outcome measures
• incontinence
• prostate cancer
• radical prostatectomy
• robotic-assisted radical prostatectomy
• volume

Acknowledgements

This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden (NPCR) steering group: Pär Stattin (chair), Ingela Franck Lissbrant (co-chair), Camilla Thellenberg, Eva Johansson, Magnus Törnblom, Stefan Carlsson, David Robinson, Mats Andén, Ola Bratt, Jonas Hugosson, Maria Nyberg, Per Fransson, Fredrik Sandin, Karin Hellström, Gert Malmberg and Hans Joelsson.

Disclosure statement

RAG has received lecture fees and reimbursements for travel expenses from IPSEN and Astellas. All other authors report no conflict of interest in any stage of this research work.

Data availability statement

The dataset for this study was pseudonymised, the personal identity number for men in the PCBase RAPID have been deleted and replaced by a code. The code key is kept at the National Board of Health and Welfare. Due to the large number of variables, and since there is a code key, this dataset is considered not to be fully anonymised. The following restrictions therefore apply: we are not allowed to share data on individual study subjects with other researchers, nor to upload such data on an open server. However, we can provide access to the dataset on a remote server on demand where analyses can be performed and aggregated data in Figures and Tables can be exported, but no data on individual participants can be exported. Researchers apply for collaborations based on data in PCBase contact: [email protected]. After approval, a study file will be uploaded to a remote access server. Users will be charged for software licenses, administration, and data management.

Additional information

Funding

This study was supported by [The Swedish Cancer Society]; under Grant [2019-0030]; [Uppsala County Council] and [the Swedish state under the agreement between the Swedish government and the county councils (the ALF-agreement)]. These grants were unconditional and the funding organisations have no influence on the work performed.