Cognitive Ability as a Non-modifiable Risk Factor for Post-prostatectomy Urinary Incontinence: A Double-Blinded, Prospective, Single-Center Trial

Abstract

Introduction: Urinary incontinence (UI) is a wide-spread and feared side-effect of conventional or even robot-assisted laparoscopic prostatectomy (RALP) due to its high impact on patients' quality of life (QoL). Non-modifiable risk factors for UI have already been identified – on surgical and patient side. Yet, to our knowledge, focus thus far has not been placed on functional aspects regarding general cognitive ability.Materials and Methods: This is an observational single-center, prospective, double-blinded evaluation of 109 RALPs performed between 07/2020 and 03/2021. All patients underwent a Mini Mental State Examination (MMSE) prior to surgery to evaluate their cognitive ability. Early post-prostatectomy incontinence (PPI) was evaluated using a standardized 1 h pad test performed 24 h after removal of the urinary catheter. The association between MMSE results and PPI were evaluated using univariate and multivariate logistic regression models.Results: Multivariate logistic regression analyses identified MMSE results and nerve sparing (NS) as independent predictors for PPI in patients with an intermediate MMSE result (25–27 points) having a 3.17 times higher risk of PPI when compared to patients with a good MMSE result (≥28) (95% Confidence Interval (CI): 1.22–9.06, p = 0.023), while patients without NS had a 3.53 times higher risk of PPI when compared to patients with NS (95% CI: 1.54–11.09, p = 0.006).Conclusion: A lower cognitive ability should be treated as a non-modifiable risk-factor for early PPI. In the future it could find its place as a clinical screening tool to identify patients who require more attention especially in the pre-, but also in the postoperative phase.

Understanding long-term continence rates after robot-assisted laparoscopic prostatectomy – one-year follow-up on “Cognitive ability as a non-modifiable risk factor for post-prostatectomy urinary incontinence”

“…As mentioned in our study about the influence of CoAb on ePPI ( 8 ), the 12-month follow-up of the trial should greatly further our understanding of the influence CoAb has on the emergence of PPI or on the recovery of continence.…”

“…This study is the 12-month follow-up evaluation of our previously published study “Cognitive ability as a non-modifiable risk factor for post-prostatectomy urinary incontinence: a double-blinded, prospective, single-center trial” ( 8 ).…”

“…Indications and exclusion criteria were described as followed ( 8 ): The indication for RALP was localized prostate cancer (PCa) detected by biopsy. All patients were staged according to current guidelines (German S3 Guidelines, EAU Guidelines, respectively) ( 16 , 17 ).…”

“…The aim of this follow-up was – after assessing the interrelation between MMSE and PPI in the very early phase (one day after catheter removal 5–7 days post-surgery) and showing that there is a significant correlation between a bad MMSE result and PPI occurrence ( 8 ) – to evaluate the long-term influence of a bad MMSE result on PPI (after 12 months).…”

“…Although the International Consultation on Incontinence-Research Society recommends pelvic floor muscle exercise (PFME)/ pelvic floor muscle training (PFMT) prior to RPE to prevent PPI or shorten the time of continence recovery postoperatively ( 12 ) and guidelines recommend their use ( 13 ), the influence of PFME/PFMT (pre- and postoperatively) on the convalescence after RPE remains uncertain ( 8 ).…”