Continence after LRP recovered more slowly in diabetic prostate cancer patients
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.”
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By Sarah Guy