Treatment of post-prostatectomy urinary incontinence and erectile dysfunction: there is insufficient utilisation of care
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ORIGINAL ARTICLE
Treatment of post‑prostatectomy urinary incontinence and erectile dysfunction: there is insufficient utilisation of care in German cancer survivors Martin Baunacke1 · Maria‑Luisa Schmidt1 · Christer Groeben1 · Angelika Borkowetz1 · Christian Thomas1 · Rainer Koch1 · Falk Hoffmann2 · Felix K. H. Chun3 · Lothar Weissbach4 · Johannes Huber1 Received: 14 August 2020 / Accepted: 9 November 2020 © The Author(s) 2020
Abstract Purpose Treatment of post-prostatectomy urinary incontinence (UI) and erectile dysfunction (ED) increases quality of life (QoL). Aim of our study was to evaluate the utilisation of care among patients with post-prostatectomy UI and ED in Germany. Methods The HAROW study documented treatment of patients with localised prostate cancer (≤ T2c) in Germany. 1260 patients underwent radical prostatectomy (RP). Patients answered validated questionnaires after a median follow-up of 6.3 years. Response rate was 76.8%. Results Median age at RP was 65 (IQR 60–69) years. 14% (134/936) used more than one pad per day for UI. 25% (26/104, 30 missing) of UI patients underwent surgery to improve continence. Of patients without surgery, 41% (31/75) reported a moderate-to-severe issue concerning their incontinence with worse mental health and QoL. 81% (755/936) patients were unable to have an erection firm enough for sexual intercourse. Of all ED patients, 40% (319/793) used ED treatment regularly or tried it at least once. 49% (243/499) of patients with interest in sex never tried ED treatment. In multivariate analysis, patients not using ED treatments were older (≥ 70 years OR 4.1), and more often had preoperative ED (OR 2.3) and less interest in sex (OR 2.2). Nevertheless, 30% (73/240) of these patients had moderate-to-severe issues with their ED reporting worse mental health and QoL. Conclusion Almost half of the patients without post-prostatectomy UI and ED treatment reported moderate-to-severe issues with a significant decrease in QoL. This indicates an insufficient utilisation of care in Germany. Keywords Prostatectomy · Erectile dysfunction · Incontinence · Health services research
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03526-z) contains supplementary material, which is available to authorized users. * Johannes Huber johannes.huber@uniklinikum‑dresden.de 1
Department of Urology, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
2
Department of Health Services Research, Carl Von Ossietzky University, Ammerlaender Heerstrasse 140, 26111 Oldenburg, Germany
3
Department of Urology, Goethe-University Hospital, Theodor‑Stern‑Kai 7, 60590 Frankfurt, Germany
4
Health Research for Men gGmbH, Gfm, Claire‑Waldoff‑Strasse 3, 10117 Berlin, Germany
Urinary incontinence (UI) and erectile dysfunction (ED) are the two most relevant side effects after radical prostatectomy (RP). Reported UI rates after RP vary between four and 40% [1], and ED rates vary between 10 and 69% [2]. Both functional outcomes
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