Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population

Jay T. Bishoff, Garrick Motley, Scott A. Optenberg, Catherine R. Stein, Kathleen A. Moon, Scott M. Browning, Edmund Sabanegh, John P. Foley, Ian M. Thompson

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Purpose: Since 1991 we have performed more than 300 anatomical radical perineal prostatectomies at Brooke Army and Wilford Hall Medical Centers, and were initially aware of 8 patients who presented with unsolicited postoperative fecal incontinence. We determined the incidence of fecal and urinary incontinence following radical prostatectomy, defined parameters to identify patients at risk for fecal complaints following radical prostatectomy, and estimated the impact of fecal incontinence on lifestyle and activities. Materials and Methods: Initially a validated 26-question telephone survey was used to evaluate 227 patients who had previously undergone radical prostatectomy at 1 of our 2 institutions. Based on results of the telephone survey a national survey was mailed to 1,200 radical prostatectomy patients randomly selected from a nationwide database of Department of Defense health care system beneficiaries. All patients had undergone radical perineal or retropubic prostatectomy at least 12 months before being contacted for the survey. Results: Responses to the telephone survey from 227 patients revealed that fecal incontinence was a problem after radical retropubic (5%) and perineal (18%) prostatectomy and less than 50% of those with fecal incontinence had told the physician. Our mail survey (response rate 80% and 78% usable for analysis, 784 radical perineal and 123 perineal) strongly indicated that fecal incontinence after radical prostatectomy is a problem nationwide. Frequency of fecal incontinence (daily, weekly, monthly or less than monthly occurrences) was significantly higher among radical perineal (3, 9, 3 and 16%) compared to retropubic prostatectomy (2, 5, 3, and 8%) patients (p = 0.002). Fecal incontinence had a significant negative effect on patient social or entertainment activities (p = 0.029), and travel and vacation plans (p = 0.043). Radical perineal compared to retropubic prostatectomy patients were more likely to wear a pad for stool leakage (p = 0.013), experienced more accidents (p = 0.001), had larger amounts of stool leakage (p = 0.002) and had less formed stools (p = 0.001). Of radical perineal prostatectomy patients only 14% and of retropubic only 7% with fecal incontinence had ever told a health care provider about it, even when the incontinence was severe. Responses to our survey concerning urinary incontinence showed that radical perineal prostatectomy patients had a lower rate of urinary incontinence immediately after prostatectomy compared to retropubic (79 versus 85%, p = 0.043). A higher proportion of perineal patients reported that all urinary leakage had ceased, that is full continence had returned (perineal 70%, retropubic 53%, p = 0.001). A smaller proportion of perineal patients found it necessary to wear a pad to protect from urinary incontinence (perineal 39%, retropubic 56%, p = 0.004). Conclusions: Fecal incontinence following radical prostatectomy occurs more frequently than previously recognized. In general fecal incontinence among radical perineal and retropubic prostatectomy patients surpasses the expected incidence rate of 4% for this age group (60 to 70 years) but incidence is significantly higher for radical perineal prostatectomy patients. However, radical perineal prostatectomy patients have a significantly lower incidence of urinary incontinence than those treated with retropubic prostatectomy. Surgeons who perform radical retropubic and perineal prostatectomy should be aware of the possibility of fecal and/or urinary incontinence and associated symptoms.

Original languageEnglish (US)
Pages (from-to)454-458
Number of pages5
JournalJournal of Urology
Volume160
Issue number2
DOIs
StatePublished - Aug 1998
Externally publishedYes

Fingerprint

Fecal Incontinence
Urinary Incontinence
Prostatectomy
Incidence
Population
Telephone

Keywords

  • Fecal incontinence
  • Prostatectomy
  • Prostatic neoplasms
  • Urinary incontinence

ASJC Scopus subject areas

  • Urology

Cite this

Bishoff, J. T., Motley, G., Optenberg, S. A., Stein, C. R., Moon, K. A., Browning, S. M., ... Thompson, I. M. (1998). Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population. Journal of Urology, 160(2), 454-458. https://doi.org/10.1016/S0022-5347(01)62924-0

Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population. / Bishoff, Jay T.; Motley, Garrick; Optenberg, Scott A.; Stein, Catherine R.; Moon, Kathleen A.; Browning, Scott M.; Sabanegh, Edmund; Foley, John P.; Thompson, Ian M.

In: Journal of Urology, Vol. 160, No. 2, 08.1998, p. 454-458.

Research output: Contribution to journalArticle

Bishoff, JT, Motley, G, Optenberg, SA, Stein, CR, Moon, KA, Browning, SM, Sabanegh, E, Foley, JP & Thompson, IM 1998, 'Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population', Journal of Urology, vol. 160, no. 2, pp. 454-458. https://doi.org/10.1016/S0022-5347(01)62924-0
Bishoff, Jay T. ; Motley, Garrick ; Optenberg, Scott A. ; Stein, Catherine R. ; Moon, Kathleen A. ; Browning, Scott M. ; Sabanegh, Edmund ; Foley, John P. ; Thompson, Ian M. / Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population. In: Journal of Urology. 1998 ; Vol. 160, No. 2. pp. 454-458.
@article{7667ddd6acc641f18ab88503d0851bc8,
title = "Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population",
abstract = "Purpose: Since 1991 we have performed more than 300 anatomical radical perineal prostatectomies at Brooke Army and Wilford Hall Medical Centers, and were initially aware of 8 patients who presented with unsolicited postoperative fecal incontinence. We determined the incidence of fecal and urinary incontinence following radical prostatectomy, defined parameters to identify patients at risk for fecal complaints following radical prostatectomy, and estimated the impact of fecal incontinence on lifestyle and activities. Materials and Methods: Initially a validated 26-question telephone survey was used to evaluate 227 patients who had previously undergone radical prostatectomy at 1 of our 2 institutions. Based on results of the telephone survey a national survey was mailed to 1,200 radical prostatectomy patients randomly selected from a nationwide database of Department of Defense health care system beneficiaries. All patients had undergone radical perineal or retropubic prostatectomy at least 12 months before being contacted for the survey. Results: Responses to the telephone survey from 227 patients revealed that fecal incontinence was a problem after radical retropubic (5{\%}) and perineal (18{\%}) prostatectomy and less than 50{\%} of those with fecal incontinence had told the physician. Our mail survey (response rate 80{\%} and 78{\%} usable for analysis, 784 radical perineal and 123 perineal) strongly indicated that fecal incontinence after radical prostatectomy is a problem nationwide. Frequency of fecal incontinence (daily, weekly, monthly or less than monthly occurrences) was significantly higher among radical perineal (3, 9, 3 and 16{\%}) compared to retropubic prostatectomy (2, 5, 3, and 8{\%}) patients (p = 0.002). Fecal incontinence had a significant negative effect on patient social or entertainment activities (p = 0.029), and travel and vacation plans (p = 0.043). Radical perineal compared to retropubic prostatectomy patients were more likely to wear a pad for stool leakage (p = 0.013), experienced more accidents (p = 0.001), had larger amounts of stool leakage (p = 0.002) and had less formed stools (p = 0.001). Of radical perineal prostatectomy patients only 14{\%} and of retropubic only 7{\%} with fecal incontinence had ever told a health care provider about it, even when the incontinence was severe. Responses to our survey concerning urinary incontinence showed that radical perineal prostatectomy patients had a lower rate of urinary incontinence immediately after prostatectomy compared to retropubic (79 versus 85{\%}, p = 0.043). A higher proportion of perineal patients reported that all urinary leakage had ceased, that is full continence had returned (perineal 70{\%}, retropubic 53{\%}, p = 0.001). A smaller proportion of perineal patients found it necessary to wear a pad to protect from urinary incontinence (perineal 39{\%}, retropubic 56{\%}, p = 0.004). Conclusions: Fecal incontinence following radical prostatectomy occurs more frequently than previously recognized. In general fecal incontinence among radical perineal and retropubic prostatectomy patients surpasses the expected incidence rate of 4{\%} for this age group (60 to 70 years) but incidence is significantly higher for radical perineal prostatectomy patients. However, radical perineal prostatectomy patients have a significantly lower incidence of urinary incontinence than those treated with retropubic prostatectomy. Surgeons who perform radical retropubic and perineal prostatectomy should be aware of the possibility of fecal and/or urinary incontinence and associated symptoms.",
keywords = "Fecal incontinence, Prostatectomy, Prostatic neoplasms, Urinary incontinence",
author = "Bishoff, {Jay T.} and Garrick Motley and Optenberg, {Scott A.} and Stein, {Catherine R.} and Moon, {Kathleen A.} and Browning, {Scott M.} and Edmund Sabanegh and Foley, {John P.} and Thompson, {Ian M.}",
year = "1998",
month = "8",
doi = "10.1016/S0022-5347(01)62924-0",
language = "English (US)",
volume = "160",
pages = "454--458",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population

AU - Bishoff, Jay T.

AU - Motley, Garrick

AU - Optenberg, Scott A.

AU - Stein, Catherine R.

AU - Moon, Kathleen A.

AU - Browning, Scott M.

AU - Sabanegh, Edmund

AU - Foley, John P.

AU - Thompson, Ian M.

PY - 1998/8

Y1 - 1998/8

N2 - Purpose: Since 1991 we have performed more than 300 anatomical radical perineal prostatectomies at Brooke Army and Wilford Hall Medical Centers, and were initially aware of 8 patients who presented with unsolicited postoperative fecal incontinence. We determined the incidence of fecal and urinary incontinence following radical prostatectomy, defined parameters to identify patients at risk for fecal complaints following radical prostatectomy, and estimated the impact of fecal incontinence on lifestyle and activities. Materials and Methods: Initially a validated 26-question telephone survey was used to evaluate 227 patients who had previously undergone radical prostatectomy at 1 of our 2 institutions. Based on results of the telephone survey a national survey was mailed to 1,200 radical prostatectomy patients randomly selected from a nationwide database of Department of Defense health care system beneficiaries. All patients had undergone radical perineal or retropubic prostatectomy at least 12 months before being contacted for the survey. Results: Responses to the telephone survey from 227 patients revealed that fecal incontinence was a problem after radical retropubic (5%) and perineal (18%) prostatectomy and less than 50% of those with fecal incontinence had told the physician. Our mail survey (response rate 80% and 78% usable for analysis, 784 radical perineal and 123 perineal) strongly indicated that fecal incontinence after radical prostatectomy is a problem nationwide. Frequency of fecal incontinence (daily, weekly, monthly or less than monthly occurrences) was significantly higher among radical perineal (3, 9, 3 and 16%) compared to retropubic prostatectomy (2, 5, 3, and 8%) patients (p = 0.002). Fecal incontinence had a significant negative effect on patient social or entertainment activities (p = 0.029), and travel and vacation plans (p = 0.043). Radical perineal compared to retropubic prostatectomy patients were more likely to wear a pad for stool leakage (p = 0.013), experienced more accidents (p = 0.001), had larger amounts of stool leakage (p = 0.002) and had less formed stools (p = 0.001). Of radical perineal prostatectomy patients only 14% and of retropubic only 7% with fecal incontinence had ever told a health care provider about it, even when the incontinence was severe. Responses to our survey concerning urinary incontinence showed that radical perineal prostatectomy patients had a lower rate of urinary incontinence immediately after prostatectomy compared to retropubic (79 versus 85%, p = 0.043). A higher proportion of perineal patients reported that all urinary leakage had ceased, that is full continence had returned (perineal 70%, retropubic 53%, p = 0.001). A smaller proportion of perineal patients found it necessary to wear a pad to protect from urinary incontinence (perineal 39%, retropubic 56%, p = 0.004). Conclusions: Fecal incontinence following radical prostatectomy occurs more frequently than previously recognized. In general fecal incontinence among radical perineal and retropubic prostatectomy patients surpasses the expected incidence rate of 4% for this age group (60 to 70 years) but incidence is significantly higher for radical perineal prostatectomy patients. However, radical perineal prostatectomy patients have a significantly lower incidence of urinary incontinence than those treated with retropubic prostatectomy. Surgeons who perform radical retropubic and perineal prostatectomy should be aware of the possibility of fecal and/or urinary incontinence and associated symptoms.

AB - Purpose: Since 1991 we have performed more than 300 anatomical radical perineal prostatectomies at Brooke Army and Wilford Hall Medical Centers, and were initially aware of 8 patients who presented with unsolicited postoperative fecal incontinence. We determined the incidence of fecal and urinary incontinence following radical prostatectomy, defined parameters to identify patients at risk for fecal complaints following radical prostatectomy, and estimated the impact of fecal incontinence on lifestyle and activities. Materials and Methods: Initially a validated 26-question telephone survey was used to evaluate 227 patients who had previously undergone radical prostatectomy at 1 of our 2 institutions. Based on results of the telephone survey a national survey was mailed to 1,200 radical prostatectomy patients randomly selected from a nationwide database of Department of Defense health care system beneficiaries. All patients had undergone radical perineal or retropubic prostatectomy at least 12 months before being contacted for the survey. Results: Responses to the telephone survey from 227 patients revealed that fecal incontinence was a problem after radical retropubic (5%) and perineal (18%) prostatectomy and less than 50% of those with fecal incontinence had told the physician. Our mail survey (response rate 80% and 78% usable for analysis, 784 radical perineal and 123 perineal) strongly indicated that fecal incontinence after radical prostatectomy is a problem nationwide. Frequency of fecal incontinence (daily, weekly, monthly or less than monthly occurrences) was significantly higher among radical perineal (3, 9, 3 and 16%) compared to retropubic prostatectomy (2, 5, 3, and 8%) patients (p = 0.002). Fecal incontinence had a significant negative effect on patient social or entertainment activities (p = 0.029), and travel and vacation plans (p = 0.043). Radical perineal compared to retropubic prostatectomy patients were more likely to wear a pad for stool leakage (p = 0.013), experienced more accidents (p = 0.001), had larger amounts of stool leakage (p = 0.002) and had less formed stools (p = 0.001). Of radical perineal prostatectomy patients only 14% and of retropubic only 7% with fecal incontinence had ever told a health care provider about it, even when the incontinence was severe. Responses to our survey concerning urinary incontinence showed that radical perineal prostatectomy patients had a lower rate of urinary incontinence immediately after prostatectomy compared to retropubic (79 versus 85%, p = 0.043). A higher proportion of perineal patients reported that all urinary leakage had ceased, that is full continence had returned (perineal 70%, retropubic 53%, p = 0.001). A smaller proportion of perineal patients found it necessary to wear a pad to protect from urinary incontinence (perineal 39%, retropubic 56%, p = 0.004). Conclusions: Fecal incontinence following radical prostatectomy occurs more frequently than previously recognized. In general fecal incontinence among radical perineal and retropubic prostatectomy patients surpasses the expected incidence rate of 4% for this age group (60 to 70 years) but incidence is significantly higher for radical perineal prostatectomy patients. However, radical perineal prostatectomy patients have a significantly lower incidence of urinary incontinence than those treated with retropubic prostatectomy. Surgeons who perform radical retropubic and perineal prostatectomy should be aware of the possibility of fecal and/or urinary incontinence and associated symptoms.

KW - Fecal incontinence

KW - Prostatectomy

KW - Prostatic neoplasms

KW - Urinary incontinence

UR - http://www.scopus.com/inward/record.url?scp=0032322379&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032322379&partnerID=8YFLogxK

U2 - 10.1016/S0022-5347(01)62924-0

DO - 10.1016/S0022-5347(01)62924-0

M3 - Article

C2 - 9679897

AN - SCOPUS:0032322379

VL - 160

SP - 454

EP - 458

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 2

ER -