The effects of psychological factors on urinary incontinence after robotic radical prostatectomy: pilot study

Urinary incontinence (UI) is a frequent complication of radical prostatectomy (RP), and identifying preoperative predictors may assist in patient selection and continence rehabilitation. We investigated the association between preoperative psychological factors and UI after RP. Consenting patients planned for RP were recruited prospectively to this pilot study. They responded to preoperative psychological surveys, including a depression anxiety stress scale, coping behavior questionnaire, general self-efficacy scale, revised life orientation test and locus of control scale (LCS). Incontinence severity was assessed by the International Consultation on Incontinence Questionnaire -Short Form (ICIQ-SF) and daily pad usage at 6 months after surgery. Correlation tests and linear regression models evaluated the association between psychological factors and UI. Twenty-five men with a median age of 69 years were enrolled. Continence outcomes at 6 months were a median ICIQ-SF score of 11 (Interquartile range (IQR) 7-14) and a median use of 2 pads per day (IQR 1-5). LCS was linearly correlated to ICIQ-SF scores (p = 0.05) and daily pad use (p = 0.005). Age and pathological staging were also linearly correlated to incontinence severity. LCS remained linearly associated with daily pad use on multivariate analysis adjusting for age and pathology (beta = 0.61, p = 0.007). Locus of control is a psychological predictor for post-RP UI severity, and patients with external control may be prone to worse incontinence. The LCS may be used when counseling patients before surgery in order to clarify expectations regarding postoperative continence. Future studies to evaluate whether psychological intervention may be beneficial for continence rehabilitation are warranted.