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

• Bossert K
• Ramakrishnan VM
• Seifert B
• Lehmann K
• Hefermehl

• KMID: 2400898
• DOI: http://doi.org/10.5213/inj.1735000.500

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*