Friday, July 13, 2012

Radical Prostatectomy Tied to Need for Bladder Surgery

By Aparna Narayanan
NEW YORK (Reuters Health) Jun 29 - One in 20 men who have their prostate gland removed may need a second surgery for severe loss of bladder control, new research from Canada suggests.
Based on more than 25,000 men who had a radical prostatectomy, the study also found that rates of subsequent surgery for urinary incontinence doubled between five and 15 years after the first operation.
"The risk of incontinence will continue and (will) increase from a cancer survivor's perspective," said lead author Dr. Robert Nam, from the University of Toronto.
The study, published June 15 in the Journal of Urology, is the first to suggest that urinary incontinence may be a long-term problem for men many years after their prostate surgery, according to the researchers.
"Doctors should discuss with patients the risk of needing incontinence surgery after radical prostatectomy," said Dr. Nam, adding that physicians themselves need to be more aware that bladder issues can persist even 15 years after prostate surgery.
He and his colleagues tracked hospital and cancer registry data for 25,346 men who underwent radical prostatectomy between 1993 and 2006.
Overall, nearly 5% of these men had follow-up operations for bladder issues.
And the number of men getting incontinence surgery almost doubled over time, from 2.6% at five years post-prostate surgery to 4.8% after 15 years.
If the prostatectomy was done after age 60, a man's risk of needing a subsequent surgery for incontinence doubled, Dr. Nam's team found.
Among the 15% of study subjects who needed radiation treatment after prostate removal, chances of needing incontinence surgery were 50% greater than those who didn't get radiation.
The experience level of the surgeon who performed the original prostatectomy also influenced a man's chances of needing bladder surgery.
Men whose surgeons did more than 48 prostatectomies a year were half as likely to need incontinence surgery than men whose surgeons did a lower volume of prostate removals.
The more surgeries a doctor does, "the better the outcome in terms of patients staying dry," said Dr. Nam.
The finding further confirms the need for patients to choose surgeons and medical centers with deep experience in treating prostate cancer, said Dr. Peter Scardino, a prostate cancer surgeon at Memorial Sloan-Kettering Cancer Center in New York, who was not involved in the study.
"It suggests the risks of having surgery are higher perhaps than is commonly thought or understood," Dr. Scardino told Reuters Health.
The new study was funded by a grant from the Ontario government, but one author declared a financial interest in several companies that make incontinence drugs.
"It's a tricky decision" whether or not to have a prostatectomy, but men now have an actual measure of incontinence risk from research based upon a large population group, Dr. Scardino noted.



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