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24-01-2010 | Oncology | Article

Continence after LRP recovered more slowly in diabetic prostate cancer patients

Abstract

Free abstract

MedWire News: Men with Type 2 diabetes mellitus need longer to recover continence after laparoscopic radical prostatectomy (LRP) than their non-diabetic counterparts, report researchers.

In addition, the researchers found that prostate cancer patients who had been diabetic 5 years or more had an almost five times increased risk for incontinence after surgery than men who had had the condition for less than 5 years.

However, despite worse rates 3 months after surgery, overall return to continence was not affected long term in diabetic men.

“Urinary incontinence remains a clinically important complication after radical prostatectomy and has a significant negative impact on patient quality of life,” explain Jens Rassweiler, from the University of Heidelberg in Helibronn, Germany, and colleagues.

A group of 270 LRP patients, half of whom had Type 2 diabetes, were matched according to factors including age, body mass index (BMI), preoperative prostate specific antigen, and clinical stage.

Operative and post-operative outcomes were compared between diabetic and nondiabetic men, and all patients were followed-up for 24 months after surgery to assess continence, measured using the International Continence Society questionnaire. Patients who used more than one pad daily and/or who experienced urine leak during coughing and/or during the night were considered incontinent.

Early continence (0–3 months) was observed in significantly more nondiabetic than diabetic patients, at 57.8% compared with 43.7%. However, the difference in numbers leveled out as follow-up progressed, with only six diabetic and seven nondiabetic patients incontinent 24 months after surgery.

Interestingly, the researchers found that rates of continence in patients who had diabetes for 5 years or more were significantly less than those who had the condition for less than 5 years, at 36% versus 50% after 3 months, 64% versus 82% at 12 months, and 92% versus 99% at 24 months after surgery.

“The high incidence of [post-LRP incontinence] in diabetics may be explained by diabetic neuropathy affecting the autonomic nerve fibers innervating the bladder neck and sphincters,” write Rassweiler et al in The Journal of Urology.

They conclude: “Diabetic patients, especially those with diabetes mellitus of 5 or more years undergoing LRP, should be carefully counseled about the negative impact of [the condition] on post-operative continence status and the time of continence recovery.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Sarah Guy

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