Int Neurourol J.  2017 Dec;21(4):302-308. 10.5213/inj.1735000.500.

Urinary Incontinence-85: An Expanded Prostate Cancer Composite (EPIC) Score Cutoff Value for Urinary Incontinence Determined Using Long-term Functional Data by Repeated Prospective EPIC-Score Self-assessment After Radical Prostatectomy

Affiliations
  • 1Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland. lukas.hefermehl@ksb.ch
  • 2University of Louisville School of Medicine, Louisville, KY, USA.
  • 3Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.

Abstract

PURPOSE
To determine an objective cutoff value (COV) for urinary incontinence (UI) using the Expanded Prostate Cancer Composite (EPIC) score after radical prostatectomy (RP).
METHODS
From 2004-2013, all RP patients at our institution completed the EPIC urinary domain (EPIC-UD) questionnaire preoperatively and 6 weeks; 3, 6, 9, 12, and 18 months postoperatively; and yearly thereafter. The EPIC-UD is composed of several questions, 4 of which address UI qualitatively (EPIC-UI). Furthermore, patients were asked to complete a global quality of life (QoL) questionnaire regarding continence. The EPIC COV was calculated using receiver operating characteristic (ROC) analysis. Correlations between the EPIC-UI and quantitative QoL were evaluated using the Kendall-Tau test.
RESULTS
We analyzed 239 patients with a median age of 63 years (interquartile range [IQR], 59-66 years), a median follow-up of 48 months (IQR, 30-78 months) and a median preoperative EPIC-UI score of 100 (IQR, 91.75-100). The ROC analysis for the distinction between EPIC-UI and the use of ≤1 pad/day yielded an EPIC-UI COV of >85, which we termed the UI-85, with an area under the curve of 0.857 (P<0.0001). A stronger correlation was seen between QoL scores and the UI-85 (1 year postoperatively: correlation coefficient [CC], 0.592; P<0.0001) than between QoL and not using a pad (CC, 0.512; P<0.0001).
CONCLUSIONS
The calculated COV of the EPIC-UI for continence was 85. UI is a multidimensional condition that cannot be adequately characterized by a single piece of information, such as pad usage only. Hence, the UI-85 represents a nuanced and straightforward tool for monitoring and comparing continence between different time points and cohorts in a multidimensional and objective manner.

Keyword

Urinary Incontinence; Self-Assessment; ROC Curve; Prostatectomy

MeSH Terms

Cohort Studies
Follow-Up Studies
Humans
Prospective Studies*
Prostate*
Prostatectomy*
Prostatic Neoplasms*
Quality of Life
ROC Curve
Self-Assessment*
Urinary Incontinence*
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