Dr. Shaw and Dr. Hampson on understanding incontinence’s impact on men

Opinion
Video

"I think as urologists that treat incontinence, both Dr. Shaw and I probably have the experience of talking to many men who actually never pursue surgical treatment for their incontinence, but they still want to understand what the options are," says Lindsay A. Hampson, MD, MAS.

In this video, Nathan M. Shaw, MD, and Lindsay A. Hampson, MD, MAS, share questions that arise from the Neurourology and Urodynamics study, “How older men live with stress urinary incontinence: Patient experience and navigation to treatment.” Shaw is an assistant professor of urology and an assistant professor of plastic and reconstructive surgery at Medstar Georgetown University Hospital in Washington, DC. Hampson is an associate professor of urology associate chair of education and Residency Program Director at the University of California, San Francisco.

Transcription:

What questions arise from this study?

Shaw: I think one of the main questions that comes to my mind is, is there a population of men who are simply never being offered even evaluation for this problem? That's what makes me concerned as far as that disconnect between the number of men who we know are suffering from incontinence and those that pursue surgical management, and again, we have those data points. I think this work gives us a little bit of insight into that gray area that certainly there are those men who are being offered treatment by experts in the field and are still electing not to pursue treatment for a variety of reasons. And that's completely legitimate and understandable. But what makes me concerned and is an open question is, what about those men who don't get to that stage? That's one big question for me. The other one, and this is apropos to Dr. Hampson's point is, even those patients who are presented options, maybe before they're necessarily candidates for that, is there a benefit to that? Is there a benefit to having all patients who undergo prostate cancer surgery, meet with someone to discuss these things, even if it never becomes a bothersome issue for them? That longer runway, particularly to entertain the risks of another surgery, might make a lot of sense for patients. To add an anecdote to that, I saw a patient within the last week, who was 1 month out from their prostatectomy and was just very interested in hearing what those options were, despite the fact they had, by all measures, mild or no incontinence, and mild or no issues around erection, which I know is not the point of this, but the idea being that I think long runways to understand those options and understand what may or may not be in their future, could be a tremendous benefit to those patients.

Hampson: I think as urologists that treat incontinence, both Dr. Shaw and I probably have the experience of talking to many men who actually never pursue surgical treatment for their incontinence, but they still want to understand what the options are. That's fair, to know what the options look like, and I am always happy to have those conversations with people about, let's lay out what things look like, and what's your trajectory likely to be? And how do those options change in the future? Is there a time point at which we would say, "Okay, those options aren't good for you anymore." So asking and answering those questions is really helpful to people. The other thing that I would say, in terms of future questions is, 1 thing that to me stood out in our interviews with men is just the lifestyle changes that they made as a result of their leakage. We talk about quality-of-life impacts, right? We can measure some quality-of-life scores and understand how incontinence [affects] people's lives. But I think 1 thing you really get from listening to these interviews is the actual impacts that they had. You hear about how people stopped doing hobbies that they loved, because the incontinence made it impossible for them to do it. You've heard about people limiting their social circle and becoming more isolated because of the incontinence. You've heard about people who decrease their physical activity in 1 way or another because of the leakage. Understanding these examples, I think, is really important to actually quantify what that quality-of-life impact really means. I hope that future research can more objectively assess those types of impacts so that we truly understand, when we say "quality-of-life impact of leakage," what does that actually mean? I would encourage people to actually look at the table with the quotes in it because reading these quotes about what changes people actually had to make as a result of their incontinence is very powerful. And it really makes you understand what it means to be affected by incontinence.

Shaw: I think another future direction or question that this raises is, is there a way that we can longitudinally understand these patients better as well? We ask these patients at the time that they are being evaluated for a potential incontinence surgery, sort of to look back on where they were now, but I think it would be really important to know the mindset of a patient who's immediately postoperative from a prostate cancer surgery, and how that mindset may change over time, particularly as it pertains to some of the complications that come with survivorship. And I think that it can include the possibility of additional treatments, because 1 of the findings that I'll also highlight is that for many of these men, they did OK for a period of time, particularly after their prostate cancer surgery, and then they either required salvage radiation for additional treatment, or androgen deprivation or something similar to address an ongoing cancer concern. It had significant impact on their other quality-of-life measures around incontinence. So I think this longitudinal aspect of this is something that we can continue to understand with more research questions.

This transcription was edited for clarity.

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