Pathway for post-prostatectomy urinary incontinence: impact on patient confidence and satisfaction
Between 8% and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads.
This audit aimed to assess patient satisfaction with this pathway and TENA Men pads.
Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey.
Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were ‘very confident’ about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most included ‘easy’, ‘discreet’, ‘comfortable’ and ‘unobtrusive’.
The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.
For the majority of patients who have recently been diagnosed with prostate cancer and who are, quite naturally, overwhelmed, post-surgery urinary incontinence and andrology issues may seem a small price to pay for being cancer free. However, once the wounds have healed and PSA values are undetectable, not having full control of their bladder function and/or not being able to achieve a full erection can have a significant impact on patients' general sense of wellbeing (Donovan et al, 2016).
In the short term, it is estimated that between 8% and 87% of patients experience urinary incontinence following surgery (Donovan et al, 2016; Arroyo et al, 2019; Hodges et al, 2020; Huynh et al, 2021). This wide variance may result from differing definitions of incontinence and durations from surgery. In a British study, 46% of patients were using at least one incontinence pad per day at 6 months, and this figure fell to around 30% at 12 months (Donovan et al, 2016). Only 20% of men who were able to sustain an erection firm enough for intercourse prior to surgery were able to do so at 6 months post-surgery, and two-thirds of men were still affected at 6 years post-surgery.
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