Utilization of Real-World Evidence in the Evaluation of Post-Surgical Incontinence in Men Undergoing Surgical Treatment for Benign Prostatic Hyperplasia.

INTRODUCTION AND OBJECTIVES: Post-surgical urinary incontinence (PSI) can occur after benign prostatic hyperplasia (BPH) surgery. Estimating incontinence risks across modalities largely relies upon reports from single surgeons or expert groups. Real-world data (RWD) provides a broader view of practice settings and surgeon experience. We used RWD to assess the incidence, duration, and risk factors of PSI.

METHODS: We conducted a retrospective cohort study using U.S. healthcare system electronic health records data compiled by Truveta of 97,970 men who underwent transurethral resection of the prostate, endoscopic enucleation, photoselective vaporization, prostatic urethral lift, water vapor thermal therapy, or robotic waterjet therapy from 2017 to 2024. Continence was defined by absence of incontinence codes or supplies for ≥ 2 consecutive encounters, or a continence restoring procedure. Incontinence rates were estimated using Kaplan-Meier methods.

RESULTS: PSI occurred in 6.9% of patients across all procedures within 1 month of surgery, decreasing to 3.8% at 18 months and 2.3% at 3 years. Adjusted for age and BPH procedure, rates of persistent PSI (18 months to 3 years) were independently highest with polyuria (p < 0.0001), neurological disorders (p < 0.0001), and sleep apnea (p < 0.0001). Those with baseline pre-surgical urinary retention (p < 0.0001), essential hypertension (p = 0.003), chronic kidney disease (p < 0.0001), and anticholinergic medications (p = 0.00016) were less likely to experience persistent incontinence.

CONCLUSIONS: While PSI decreased over time, 3.8% had persistent incontinence at 18 months. Certain co-morbidities were associated with higher PSI rates. RWD can provide a comprehensive view of incontinence risk in real-world practice, however, utilizing RWD to determine resolution of incontinence is challenging.