AUA, GURS, SUFU amend guideline for incontinence after prostate treatment

The American Urological Association (AUA), the Society of Genitourinary Reconstructive Surgeons (GURS), and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) have released a joint amendment to the incontinence after prostate treatment guideline, the AUA announced in a news release.¹

The updated statements are reflective of 17 studies that met the inclusion criteria.

The full guideline, which was first published in 2019, covers current diagnostic and treatment options for patients who experience incontinence after undergoing treatment for localized prostate cancer or benign prostatic hyperplasia (BPH).²

“Urinary incontinence is a prevalent and highly impactful quality of life issue that can cause stress, depression, and social isolation if left untreated. We hope this amendment serves as a useful resource for clinicians who treat stress incontinence in men after prostate therapies such as prostatectomy, radiation, and benign prostatic hypertrophy surgery. We’ve provided guidance on the impact of radiation on urinary health as well as suggestions for counseling men about the risk factors for artificial urinary sphincter erosion, among other recommendations,” said guideline amendment chair Benjamin N. Breyer, MD, MAS, FACS, in the news release.¹ Breyer is also a professor and chair of urology at the University of California, San Francisco.

In total, the guideline includes 38 recommendations on managing incontinence following prostate treatment. Updates to the guideline include:

• “Pre-treatment updates to be more inclusive of patients who will undergo treatments other than radical prostatectomy.
• Treatment updates that include new evidence on adjustable balloon devices and the efficacy and outcomes of slings.
• New discussion of counseling patients regarding risk factors of artificial urinary sphincter erosion.
• New guidance on explanation in patients presenting with infection or erosion of an artificial urinary sphincter or sling.
• Updated future directions discussing ongoing research in the field and potential future treatment options,” according to the news release.¹

These updated statements are reflective of 17 studies that met the criteria for inclusion.

“Incontinence following prostate treatment is a significant concern that profoundly affects the quality of life for many patients. This updated guideline aims to equip clinicians with the latest evidence-based strategies to manage and treat this condition effectively,” said James Quentin Clemens, MD, president of SUFU.¹ “By addressing the complexities of post-treatment incontinence, including the impact of radiation and the risks associated with artificial urinary sphincters, we strive to improve patients' outcomes and quality of life.”

In total, 9 guideline statements were updated regarding pre-treatment, treatment options, complications following surgery, and special situations. The AUS Failure Algorithm was also updated to include cystoscopy as a method for determining erosion and worsening of incontinence.³

Keith Rourke, MD, FRCSC, president of GURS, concluded in the news release,¹ “Despite a decline in [prostate-specific antigen] screening, increased use of active surveillance, and refinements in curative therapies, incontinence remains a profound issue after prostate cancer treatment. The increasing use of radical prostatectomy in patients with high-risk cancer and salvage local therapies has resulted in increased complexity and complication risk in patients presenting with urinary incontinence after prostate treatment. This AUA guideline provides up-to-date, evidence-based recommendations on the best way to evaluate, counsel, stratify, and optimize outcomes for patients with this challenging condition.”

References

1. American Urological Association releases incontinence after prostate treatment guideline amendment. News release. American Urological Association. June 27, 2024. Accessed July 10, 2024. https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-incontinence-after-prostate-treatment-guideline-amendment

2. Incontinence after Prostate Treatment: AUA/GURS/SUFU Guideline. J Urol. https://www.auanet.org/guidelines-and-quality/guidelines/incontinence-after-prostate-treatment

3. Breyer BN, Kim SK, Kirkby E, Marianes A, Vanni AJ, Westney OL. Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024). J Urol. Published online July 27, 2024. doi:10.1097/JU.0000000000004088