Patient Decision-making for Surgical Treatment of Post-prostatectomy Stress Urinary Incontinence: a Mixed-methods Exploratory Pilot Study

Overview

Journal Transl Androl Urol

Date 2023 Jun 12

PMID 37305624

Authors

Nathan M Shaw

Farnoosh Nik-Ahd

Charles Jones

Benjamin N Breyer

Louise C Walter

Rebecca Sudore

Matthew R Cooperberg

Caitlin Baussan

Kathryn Quanstrom

I Elaine Allen

Lindsay A Hampson

Affiliations

Soon will be listed here.

Abstract

Background: Male stress urinary incontinence (SUI) is a known complication following surgical intervention on the prostate, particularly following surgery for prostate cancer. Effective surgical treatments for SUI include artificial urinary sphincter (AUS) and male urethral sling. Prior data suggest that men may forego available treatment despite bothersome symptoms. The objective was to explore how men who underwent surgical correction for post-prostatectomy SUI navigated SUI treatment decisions.

Methods: Mixed method study was employed. Semi-structured interviews, participant surveys and objective clinical assessment of SUI were performed among a group of men living with incontinence after prostate cancer surgery who underwent surgery for SUI at the University of California in 2017.

Results: Eleven men were interviewed after consultation for SUI and all had complete quantitative clinical data. Surgery for SUI included AUS (n=8) and sling (n=3). There was a decrease in pads per day from 3.2 to 0.9 and no major complications. Most patients found that the impact on activities and their treating urologist were of great importance. Sexual and relationships played a variable role with some participants ranking these as "great deal of influence" and others "little or no influence". Participants who underwent AUS were more likely to cite a higher importance on "being very dry" in choosing that surgery while sling patients had more variable ranking of important factors. Participants found a variety of inputs helpful in hearing information about SUI treatment options.

Conclusions: Among a group of 11 men who underwent surgical correction for post-prostatectomy SUI, there were identifiable themes on how men make decisions, evaluate quality of life (QoL) changes and approach treatment options. Men value more than being dry with measures of individual success that can include sexual and relationship health. Furthermore the role of the Urologist remains crucial as patients relied heavily on input and discussion with their Urologist to assist in treatment decisions. These findings can be used to inform future studies of the experience of men with SUI.

Citing Articles

Exploring the Hidden Struggles: A Qualitative Insight into Urinary Incontinence Among Prostate Cancer Survivors Post-Surgery.

Sun N, Gu Y Patient Prefer Adherence. 2024; 18:1047-1058.

PMID: 38826502 PMC: 11143978. DOI: 10.2147/PPA.S461027.

Surgical treatment of male stress urinary incontinence: a knot still to be unravelled.

Geretto P, De Nunzio C, Li Marzi V, Lombardo R Transl Androl Urol. 2023; 12(10):1614-1616.

PMID: 37969771 PMC: 10643394. DOI: 10.21037/tau-23-446.

Artificial Urinary Sphincters for Moderate Post-Prostatectomy Incontinence: Current Research and Proposed Approach.

Johnson A, Mossack S, Tsambarlis P Cancers (Basel). 2023; 15(18).

PMID: 37760394 PMC: 10526785. DOI: 10.3390/cancers15184424.

Special series on the surgical management of stress urinary incontinence in men.

Chung P, Hampson L Transl Androl Urol. 2023; 12(5):829-831.

PMID: 37305640 PMC: 10251080. DOI: 10.21037/tau-2023-01.

References

Bretterbauer K, Huber E, Remzi M, Huebner W . Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations. Int Braz J Urol. 2016; 42(5):986-992. PMC: 5066896. DOI: 10.1590/S1677-5538.IBJU.2015.0194. View

Gozzi C, Becker A, Bauer R, Bastian P . Early results of transobturator sling suspension for male urinary incontinence following radical prostatectomy. Eur Urol. 2008; 54(4):960-1. DOI: 10.1016/j.eururo.2008.04.096. View

Guadagnoli E, Ward P . Patient participation in decision-making. Soc Sci Med. 1998; 47(3):329-39. DOI: 10.1016/s0277-9536(98)00059-8. View

Hampson L, Suskind A, Breyer B, Cooperberg M, Sudore R, Keyhani S . Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions. J Urol. 2021; 207(4):885-892. PMC: 8966413. DOI: 10.1097/JU.0000000000002352. View

Novara G, Ficarra V, DElia C, Secco S, Cioffi A, Cavalleri S . Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol. 2010; 184(3):1028-33. DOI: 10.1016/j.juro.2010.04.069. View

Hampson L, Cowan J, Zhao S, Carroll P, Cooperberg M . Impact of age on quality-of-life outcomes after treatment for localized prostate cancer. Eur Urol. 2015; 68(3):480-6. DOI: 10.1016/j.eururo.2015.01.008. View

Frosch D, Moulton B, Wexler R, Holmes-Rovner M, Volk R, Levin C . Shared decision making in the United States: policy and implementation activity on multiple fronts. Z Evid Fortbild Qual Gesundhwes. 2011; 105(4):305-12. DOI: 10.1016/j.zefq.2011.04.004. View

Herr H . Quality of life of incontinent men after radical prostatectomy. J Urol. 1994; 151(3):652-4. DOI: 10.1016/s0022-5347(17)35038-3. View

Resnick M, Koyama T, Fan K, Albertsen P, Goodman M, Hamilton A . Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013; 368(5):436-45. PMC: 3742365. DOI: 10.1056/NEJMoa1209978. View

10.

Kim P, Pinheiro L, Atoria C, Eastham J, Sandhu J, Elkin E . Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis. J Urol. 2012; 189(2):602-8. DOI: 10.1016/j.juro.2012.08.246. View

11.

Paterson J . Stigma associated with postprostatectomy urinary incontinence. J Wound Ostomy Continence Nurs. 2000; 27(3):168-73. DOI: 10.1016/s1071-5754(00)90054-8. View

12.

Gupta S, Ding L, Granieri M, Le N, Peterson A . Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy. Neurourol Urodyn. 2015; 35(6):733-7. DOI: 10.1002/nau.22790. View

13.

Rehder P, Gozzi C . Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol. 2007; 52(3):860-6. DOI: 10.1016/j.eururo.2007.01.110. View

14.

Nelson M, Dornbier R, Kirshenbaum E, Eguia E, Sweigert P, Baker M . Use of Surgery for Post-Prostatectomy Incontinence. J Urol. 2019; 203(4):786-791. DOI: 10.1097/JU.0000000000000618. View

15.

Michel J, Ballon J, Connor S, Johnson D, Bergman J, Saigal C . Improving Shared Decision Making in Latino Men With Prostate Cancer: A Thematic Analysis. MDM Policy Pract. 2021; 6(1):23814683211014180. PMC: 8165846. DOI: 10.1177/23814683211014180. View

16.

Berge V, Thompson T, Blackman D . Additional surgical intervention after radical prostatectomy, radiation therapy, androgen-deprivation therapy, or watchful waiting. Eur Urol. 2006; 52(4):1036-43. DOI: 10.1016/j.eururo.2006.12.012. View

17.

Stewart M, Brown J, Donner A, McWhinney I, Oates J, Weston W . The impact of patient-centered care on outcomes. J Fam Pract. 2000; 49(9):796-804. View

18.

Kumar A, Litt E, Ballert K, Nitti V . Artificial urinary sphincter versus male sling for post-prostatectomy incontinence--what do patients choose?. J Urol. 2009; 181(3):1231-5. DOI: 10.1016/j.juro.2008.11.022. View

19.

Friedl A, Bauer W, Rom M, Kivaranovic D, Luftenegger W, Brossner C . Sexuality and erectile function after implantation of an Adjustable Transobturator Male System (ATOMS) for urinary stress incontinence. A multi-institutional prospective study. Arch Ital Urol Androl. 2016; 87(4):306-11. DOI: 10.4081/aiua.2015.4.306. View

20.

Greenfield S, Kaplan S, Ware Jr J . Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985; 102(4):520-8. DOI: 10.7326/0003-4819-102-4-520. View