Urinary Incontinence after Primary Whole Gland Prostate Cryoablation: Does Function Improve at 1-year Following Treatment?
To assess changes in patient-reported rates of urinary incontinence more than 1 year following primary whole gland cryoablation of the prostate.
This is a retrospective analysis of 3973 men who underwent primary whole gland cryotherapy. The primary endpoint of analysis was the rate of urinary incontinence assessed at two different time periods (0-9 months and 10-14 months). The secondary endpoint of analysis was to assess clinicodemographic predictors of postoperative urinary incontinence in this cohort at the previously time intervals. Descriptive statistics were performed using chi-square (categorical) and Wilcoxon rank-sum (continuous) testing. Multivariable logistic regression models were used to assess the independent predictors of post-cryo urinary incontinence (PCI) at both time interval. Continence was defined as strictly pad- free.
Mean age was 70.2 years (SD±7.2), mean PSA was 9.8 ng/ml (SD±25), and Grade Group 2 or higher disease was found in 1708/ 3909 (43.7.5%) men. The mean follow-up time was 41.4 months (SD±35). Overall, 644/3897(16.5%) patients had urinary incontinence from 0-9 months following cryotherapy, compared to 139/3854 (3.6 %) from 10-12 months. The relative risk reduction of incontinence was 78.1% at 10-14 months following cryotherapy. On multivariate analysis the independent predictors for PCI within 0-9 months following cryotherapy were older age (OR 1.01, p=0.008), pretreatment Grade Group 2+ disease (OR 1.72, p<0.001), prior invasive BPH therapy (OR 2.33, p<0.001), postoperative urinary retention (OR. 1.79, p<0.001) and smaller prostate volume (OR 0.98, p=0.001). Conversely, the only predictors for PCI at 10-14 months were age (OR 1.02, p=0.02), prior invasive BPH therapy (OR 2.62, p=0.003), and postoperative urinary retention (OR 2.04, p=0.003).</p>
To the best of our knowledge this the first study assessing rates of urinary continence over time following primary whole gland cryoablation. Assessment of urinary function at 10-14 months, demonstrated a 78.1% reduction in the rates of incontinence compared to the 0-9 month time period. Age, prior BPH surgery, and postoperative urinary retention were independent predictors of both short- and long term continence following primary prostate cryoabltion. Men with these risk factors should be counseled regarding their increased risk of poor urinary function following cryoablation.