PURPOSE: to quantify and compare pre- and post-surgical incontinence pad use between men treated with radical prostatectomy (RP) for prostate cancer (PCa) and cancer-free controls, using population-based Austrian insurance claims data. METHODS: Men who underwent RP for treating PCa between 2013-2015 were identified. Cancer-free men ≥45 years with and without benign prostate hyperplasia (BPH) were used as controls. Longitudinal data on ICD-diagnoses, type of surgery, prescribed incontinence pads, and hospitals' surgery volumes were aggregated between 2011-2018 to capture pre- and up to three years post-RP follow-up. Monthly rates of pad use were calculated and compared between RP types and cancer-free controls. RESULTS: A total of 6248 RP patients, 7158 cancer-free men with BPH, and 50,257 cancer-free men without BPH were analyzed. Comparing to pre-RP (0.03, 95%CI: 0.02-0.05), RP resulted in significantly higher rates of prescribed pads (at 3 months: 12.61, 95%CI: 11.59-13.65; 12 months: 6.71, 95%CI: 6.10-7.34; 36 months: 4.91, 95%CI: 3.76-4.62). These rates were also higher than those for cancer free controls (with BPH:0.06, 95%CI: 0.04-0.09; without BPH:0.12, 95%CI: 0.10-0.14). The rate of prescribed pads after surgery continued to decline over time and remained higher among men who underwent minimally invasive RP compared to those who underwent an open procedure. CONCLUSION: Despite progress in surgical techniques, post-RP incontinence remains a prevalent adverse event. The rate of pad usage steadily improved over the first three years post RP. The rate of patients with incontinence needing pads was higher among those who were treated minimally invasive compared to open approach.

Center for Public Health Department of Epidemiology Medical University of Vienna 1090 Vienna Austria

Competence Center Integrated Care c o Austrian Health Insurance Fund 1100 Vienna Austria

Department of Cancer Epidemiology and Prevention Research Alberta Health Services Calgary AB T2S 3C3 Canada

Department of Special Surgery Division of Urology Jordan University Hospital The University of Jordan Amman 2V89 CR Jordan

Department of Urology 2nd Faculty of Medicine Charles University 150 06 Prague Czech Republic

Department of Urology Medical University of Vienna 1090 Vienna Austria

Department of Urology University of Texas Southwestern Dallas TX 75390 USA

Department of Urology Weill Cornell Medical College New York NY 10065 USA

Departments of Oncology and Community Health Sciences University of Calgary Calgary AB T2N 1N4 Canada

European Association of Urology Research Foundation NL 6803 AA Arnhem The Netherlands

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University 119435 Moscow Russia

Karl Landsteiner Institute of Urology and Andrology 3100 St Poelten Austria

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