Continence Definition After Radical Prostatectomy Using Urinary Quality of Life: Evaluation of Patient Reported Validated Questionnaires

Purpose: After radical prostatectomy continence is commonly defined as no pads except a security pad or 0 to 1 pad. We evaluated the association of pad status and urinary quality of life to determine whether security and 1 pad status differ from pad-free status to better define 0 pads as the post-prostatectomy standard. Materials and Methods: A total of 500 consecutive men underwent robot assisted radical prostatectomy from October 2003 to July 2007. Data were collected prospectively and entered into an electronic database. Postoperatively men completed self-administered validated questionnaires including questions on 1) daily pad use (0, security, 1, or 2 or more), 2) urine leakage (daily, about once weekly, less than once weekly or not at all), 3) urinary control (none, frequent dribbling, occasional dribbling or total control), 4) American Urological Association symptom score and 5) urinary quality of life. Results: Postoperatively men who indicated 0 pad use had a mean ± SE symptom score of 5.8 ± 0.3 and pleased quality of life (1.16 ± 0.08). In contrast, men with a security pad and 1 pad had a symptom score of 7.6 ± 0.7 and 9.2 ± 0.6 but mixed quality of life (2.78 ± 0.18 and 3.41 ± 0.15, respectively, p <0.0005). Conclusions: Results show a significant decrease in quality of life between no pads (1.16 or pleased), a security pad and 0 or 1 pad (2.78 and 3.41 or mixed, respectively). Findings do not support defining continence with a security pad or 0 to 1 pad. Continence should be strictly defined as 0 pads.