BackgroundOn the basis of previous analyses of the incidence of urinary incontinence (UI) after radical prostatectomy (RP), the hospital RP volume threshold in the Netherlands was gradually... Show moreBackgroundOn the basis of previous analyses of the incidence of urinary incontinence (UI) after radical prostatectomy (RP), the hospital RP volume threshold in the Netherlands was gradually increased from 20 per year in 2017, to 50 in 2018 and 100 from 2019 onwards.ObjectiveTo evaluate the impact of hospital RP volumes on the incidence and risk of UI after RP (RP-UI).Design, setting, and participantsPatients who underwent RP during 2016–2020 were identified in the claims database of the largest health insurance company in the Netherlands. Incontinence was defined as an insurance claim for ≥1 pads/d.Outcome measurements and statistical analysisThe relationship between hospital RP volume (HV) and RP-UI was assessed via multivariable analysis adjusted for age, comorbidity, postoperative radiotherapy, and lymph node dissection.Results and limitationsRP-UI incidence nationwide and by RP volume category did not decrease significantly during the study period, and 5-yr RP-UI rates varied greatly among hospitals (19–85%). However, low-volume hospitals (≤120 RPs/yr) had a higher percentage of patients with RP-UI and higher variation in comparison to high-volume hospitals (>120 RPs/yr). In comparison to hospitals with low RP volumes throughout the study period, the risk of RP-UI was 29% lower in hospitals shifting from the low-volume to the high-volume category (>120 RPs/yr) and 52% lower in hospitals with a high RP volume throughout the study period (>120 RPs/yr for 5 yr).ConclusionsA focus on increasing hospital RP volumes alone does not seem to be sufficient to reduce the incidence of RP-UI, at least in the short term. Measurement of outcomes, preferably per surgeon, and the introduction of quality assurance programs are recommended.Patient summaryIn the Netherlands, centralization of surgery to remove the prostate (RP) because of cancer has not yet improved the occurrence of urinary incontinence (UI) after surgery. Hospitals performing more than 120 RP operations per year had better UI outcomes. However, there was a big difference in UI outcomes between hospitals. Show less
The aim of this thesis was to evaluate the intriguing and relevant relationship between UI and FSD in urological practice. This relationship is addressed from anatomical, clinical and health care... Show moreThe aim of this thesis was to evaluate the intriguing and relevant relationship between UI and FSD in urological practice. This relationship is addressed from anatomical, clinical and health care points of view. The initial question was whether urologists should play a role in sexual health care of women with urinary incontinence. In chapter 2, three-dimensional anatomical econstructions and results of dissection in cadavers are described. The reconstructions illustrate the clitoral innervation in order to deduce its anatomical relationship to other pelvic structures. This is important to preserve clitoral nerves during pelvic surgery. Furthermore, this chapter evaluates the possible effects of incontinence surgery from an anatomical point of view, especially with regards to the nerves important for sexual function. In chapter 3, sexual function is evaluated among women after a sling procedure. This study attempts to clarify the impact of surgery for stress urinary incontinence on female sexual function. In addition, the relevance of the presence of preoperative coital incontinence is discussed extensively. Chapter 4 discusses the impact of female urinary incontinence on the sexual relationship with male partners. The chapters 5 and 6 overview practices, attitudes and believes of Dutch urologists towards FSD and sexual abuse. Chapter 7 analyses how Dutch incontinence nurses deal with sexuality and sexual abuse in their daily practice. Finally, chapter 8 provides a __helicopter view__ on data of this of this thesis followed by a discussion on future prospects. Show less
