557 HOW WELL PATIENT PERCEPTION OF PAD USE CORRELATES WITH THE DEGREE OF INCONTINENCE IN POST PROSTATECTOMY INCONTINENCE: THE SUFU PAD TEST STUDY

Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013

THE JOURNAL OF UROLOGY姞

e229

Urodynmaics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (I) Podium Session 12 Sunday, May 5, 2013

1:00 PM-3:00 PM

557 HOW WELL PATIENT PERCEPTION OF PAD USE CORRELATES WITH THE DEGREE OF INCONTINENCE IN POST PROSTATECTOMY INCONTINENCE: THE SUFU PAD TEST STUDY Victor Nitti*, Benjamin Brucker, New York, NY; Arthur Mourtzinos, Burlington, MA INTRODUCTION AND OBJECTIVES: The severity of post prostatectomy incontinence (PPI) often influences treatment and is best accessed by a 24-hour pad test (24PT) weight (wt). Many used # pads to determine severity of PPI, yet the accuracy of this is unproven. Our aim was to determine if patient’s perception of pad use and urine loss measured by questionnaires, reflects actual urine loss measured by 24PT. Further, we sought to determine if pad size and degree of wetness, as well as other quality of life (Qol) measures, improved the correlation with actual urine loss. METHODS: We prospectively enrolled men ⱖ6 m after prostatectomy, with incontinence, requiring daily protection. Patients were given questionnaires asking about the following variables: # pads, size of pads, and wetness of pads. They were asked a Qol question (“To what extent does urine loss affect your Qol?”). Men completed a 24PT using their own pads. The actual # of pads used, pad size, and net wt was determined. Patients completed UDI-6, IIQ-7, UCLA/RAND, IPSS. SPSS was used for statistical testing. RESULTS: 235 men from 18 sites with a mean age of 65.9 had a mean 24PT wt of 304 gm. Perception of # of pads worn was in close agreement with actual # used (table 1). Perceived and actual pad size had excellent concordance (76%, p⬍0.001). Both perceived and actual pad # had a strong positive relationship with 24PT wt. Patients that had perceived wetness of “wet” and “soaked” had pad wt significantly different from each other, and from the “almost dry” and “slightly wet” groups. Only the single item impact on Qol separated men into 4 significantly different groups based on mean 24PT wt (figure 1); all remaining incontinence questionnaires had weak correlations. CONCLUSIONS: Men with PPI accurately describe the # and size of pads collected during 24PT. The single question on QoL separated men into distinct categories. 24PT wt is currently the most reliable test of degree of PPI, but in most cases the needed information obtained is ascertained by simple questions pertaining to pad use, pad size and degree of wetness. Table 1. Association between patients perceived number of pads and actual number of pads on 24-hour pad test. 1 1-2 2 3 3-4 ⬎/⫽ 4 Perception pad pads pads pads pads pads Actual mean 1.12 1.74 2.07 3.90 4.00 5.71 (95% CI)

(.811.43)

(1.472.01)

(1.652.49)

(2.984.82)

(3.524.48)

(5.126.32)

Source of Funding: SUFU-Incontinence Study

558 10 YEAR SINGLE INSTITUTION EXPERIENCE WITH SACRAL NEUROMODULATION Anne E. Scott*, James H. Raybourn, Jennifer G. Rothschild, Douglas F. Milam, Roger R. Dmochowski, W. Stuart Reynolds, Melissa R. Kaufman, Nashville, TN INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SN) is an option in the management of urinary retention as well as medication refractory urgency/frequency (U/F) and urge incontinence (UI). Despite a variety of case series, it remains unclear which patients benefit most from this therapy. We sought to evaluate our experience with SN and identify clinical factors which predict response to therapy, need for revision and/or explantation. METHODS: We performed a retrospective review of adults who underwent SN implantation from 2000 to 2011 at our institution and abstracted demographic, clinical, perioperative and postoperative data, including indications (U/F, UI or non⫺obstructive retention) and revision/explantation rates. We defined success as a subjective 50% improvement in symptoms. RESULTS: Three hundred and ninety patients (278 women and 112 men) underwent lead implantation during the study period. Reasons for implantation included: U/F (16%), UI (58%), and retention (24%). 36 (9%) patients did not progress to generator implantation given lack of symptomatic improvement. At first follow⫺up, 83% overall reported 50% or greater symptomatic improvement, and this was maintained in 70% over an average of 2.1 (0.06⫺9.18) years. No difference in success or revision/explant rates was seen between patients with retention and those without. 134 patients (40%) required replacement, revision or explant, primarily for decrease in device function secondary to lead migration (13%) or generator failure (7%). 54 patients (16%) were explanted. Erosion or infection was rare (1%). Univariate analysis of preoperative factors found only history of TUIP in men (p⫽0.04) and severe nocturia (p⫽0.02) to be predictors of SN failure. There was an increased risk of revision in women (p⫽0.01) and non⫺diabetics (p⫽0.003) and decreased risk of explant in those with back surgery history (0.04), urge incontinence indication (p⫽0.03) and no history of procedure for urinary obstruction (p⫽0.03). CONCLUSIONS: In our experience, sacral neuromodulation is an effective, durable treatment with high success rates and low risk of complications. However, with revision rates of 40%, appropriate patient counseling is critical to insure patient expectations match outcomes. Despite the wide variety of patient pathologies treated with neuromodu-