High-volume surgeons no better at reducing postoperative incontinence

University of Gothenburg

In men who have had prostate cancer surgery, urinary incontinence is a common side effect. Its frequency varies from one surgeon to the next. In a major University of Gothenburg study, the number of surgeries performed by the urology surgeon made no difference to the patients’ incontinence risk. This surprised researchers.

Prostate cancer is the most common form of cancer in men, with some 10,000 new cases detected annually in Sweden. If the tumor has not spread, the prostate gland is often operated on, usually with a robot-assisted, laparoscopic technique.

Immediately after the procedure, almost all men are incontinent, because of disturbed activity in the sphincter (surrounding the upper part of the urethra) caused by the operation. This circular muscle is located just below the prostate. This urinary incontinence usually disappears after a few months, but there is a risk of it persisting.

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Rebecka Arnsrud Godtman, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg.
Photo: Emelie Ljunggren

High volume has no effect

In the study, researchers wanted to find out whether men operated on by surgeons performing many radical prostatectomies per year had a lower risk of becoming incontinent. Rebecka Arnsrud Godtman, associate professor (docent) of urology at the University and specialist physician in the Prostate Cancer Center at Sahlgrenska University Hospital, is the study’s first author.

“For other surgeries, patients of surgeons who perform the operations frequently are known to have fewer complications. It’s a plausible association, since ‘practice makes perfect.’ But to our surprise, we couldn’t see that link. In the men operated on by high-volume surgeons, the risk of postoperative urinary incontinence was no lower than in those whose surgeons were less experienced. This underlines the importance of feed-back to surgeons by use patient-reported outcome measures (PROM) in order to improve surgical technique to obtain better results.” Godtman says.

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