Behavioral Therapy Halves Persistent Postprostatectomy Incontinence

The study findings appear encouraging at first glance, but it is important to examine them more closely before advocating this behavioral intervention in routine practice, said Dr. David F. Penson.

First, although episodes of urinary leakage declined from 28 to "only" 13 episodes per week with the active treatment, this still means that patients had an average of 2 such episodes per day instead of 3. This level of continuing incontinence certainly would be problematic for many men.

Second, although approximately 60% of the men who underwent active treatment used fewer urinary protection pads or diapers after 8 weeks, that still leaves approximately 40% who used the same number as they did at baseline. Would these patients conclude that behavioral treatment was successful?

Behavioral therapy "likely requires considerable patient and clinician time and effort," which many may not consider to be worth the limited benefits reported here.

Dr. Penson is in urologic surgery at Vanderbilt University and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville. He reported no financial conflicts of interest. These comments are taken from his editorial accompanying Dr. Goode’s report (JAMA 2011;305:197-8).