Video

LONDON – Spironolactone is far and away the most effective therapy for resistant hypertension, according to the findings of the first randomized clinical trial comparing the aldosterone antagonist with other active agents.

“The result in favor of spironolactone is unequivocal: Spironolactone is the most effective treatment for resistant hypertension, and these results should influence treatment guidelines globally,” Dr. Bryan Williams said in presenting the PATHWAY-2 (Optimum Treatment for Drug-Resistant Hypertension) trial findings at the annual congress of the European Society of Cardiology.

Indeed, on the basis of the drug’s performance – a mean reduction in home systolic blood pressure of 8.7 mm Hg, compared with reductions of 4.03 and 4.48 mm Hg for doxazosin and bisoprolol, respectively, in the 314-patient crossover study – no one should any longer be categorized as having treatment-resistant hypertension unless they’ve first failed to achieve blood pressure control on spironolactone. And that will be a surprisingly small group, the chair of medicine at University College London said in an interview.

[email protected]

LONDON – Spironolactone is far and away the most effective therapy for resistant hypertension, according to the findings of the first randomized clinical trial comparing the aldosterone antagonist with other active agents.

“The result in favor of spironolactone is unequivocal: Spironolactone is the most effective treatment for resistant hypertension, and these results should influence treatment guidelines globally,” Dr. Bryan Williams said in presenting the PATHWAY-2 (Optimum Treatment for Drug-Resistant Hypertension) trial findings at the annual congress of the European Society of Cardiology.

Indeed, on the basis of the drug’s performance – a mean reduction in home systolic blood pressure of 8.7 mm Hg, compared with reductions of 4.03 and 4.48 mm Hg for doxazosin and bisoprolol, respectively, in the 314-patient crossover study – no one should any longer be categorized as having treatment-resistant hypertension unless they’ve first failed to achieve blood pressure control on spironolactone. And that will be a surprisingly small group, the chair of medicine at University College London said in an interview.

[email protected]

LONDON – Spironolactone is far and away the most effective therapy for resistant hypertension, according to the findings of the first randomized clinical trial comparing the aldosterone antagonist with other active agents.

“The result in favor of spironolactone is unequivocal: Spironolactone is the most effective treatment for resistant hypertension, and these results should influence treatment guidelines globally,” Dr. Bryan Williams said in presenting the PATHWAY-2 (Optimum Treatment for Drug-Resistant Hypertension) trial findings at the annual congress of the European Society of Cardiology.

Indeed, on the basis of the drug’s performance – a mean reduction in home systolic blood pressure of 8.7 mm Hg, compared with reductions of 4.03 and 4.48 mm Hg for doxazosin and bisoprolol, respectively, in the 314-patient crossover study – no one should any longer be categorized as having treatment-resistant hypertension unless they’ve first failed to achieve blood pressure control on spironolactone. And that will be a surprisingly small group, the chair of medicine at University College London said in an interview.

[email protected]

LONDON – Neither the GLP-1 receptor agonist lixisenatide nor the DPP-4 inhibitor sitagliptin significantly increased the risk of heart failure or associated hospitalizations in patients with type 2 diabetes, according to data from two large cardiovascular safety trials.

Further analysis from ELIXA (Evaluation of Lixisenatide [Lyxumia] in Acute Coronary Syndrome) showed that the hazard ratios for several secondary heart failure endpoints were 1.00 or below. Although the risk for heart failure hospitalization was found to be nine times higher in patients who had a prior history of heart failure than in those who did not, there was there was no difference between treatment with the GLP-1 (glucagon-like peptide 1) agonist or placebo.

The findings add to those already presented in June at the annual scientific sessions of the American Diabetes Association from the 6,068-patient trial, which enrolled patients with type 2 diabetes who had experienced an acute coronary syndrome within the past 6 months.

Other reassuring data on the safety of newer diabetes medicines came from an updated analysis of TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin [Januvia]). The time to first hospitalization for heart failure did not differ between the placebo and sitagliptin arms, and there were no differences between the treatments in terms of hospitalization for heart failure or cardiovascular death or hospitalization for heart failure or all-cause death with the DPP-4 (dipeptyl peptidase 4) inhibitor. TECOS enrolled nearly 15,000 patients with type 2 diabetes and concurrent cardiovascular disease who were aged 50 years or older and the primary findings have been published (N Engl J Med. 2015 July 15;373:232-42).

These trials provide accumulating evidence that there is no heart failure risk with these particular diabetes medications, Dr. Lars Rydén, professor of cardiology at the Karolinska Institute in Stockholm, commented in an interview at the annual congress of the European Society of Cardiology. Dr. Rydén added that the trial results everyone is waiting to hear about concern the cardiovascular safety of the selective sodium–glucose cotransporter-2 (SGLT-2) inhibitor empagliflozin (Jardiance).

Advance information issued by manufacturer Boehringer-Ingelheim suggests that this drug actually may lower cardiovascular risk in patients at high risk for cardiovascular events, Dr. Rydén observed. “Now, if that is true, it is the only modern glucose-lowering drug to have shown such a capacity.” Results of the EMPA-REG OUTCOME study will be presented in September at the annual meeting of the European Association for the Study of Diabetes in Stockholm.

LONDON – Neither the GLP-1 receptor agonist lixisenatide nor the DPP-4 inhibitor sitagliptin significantly increased the risk of heart failure or associated hospitalizations in patients with type 2 diabetes, according to data from two large cardiovascular safety trials.

Further analysis from ELIXA (Evaluation of Lixisenatide [Lyxumia] in Acute Coronary Syndrome) showed that the hazard ratios for several secondary heart failure endpoints were 1.00 or below. Although the risk for heart failure hospitalization was found to be nine times higher in patients who had a prior history of heart failure than in those who did not, there was there was no difference between treatment with the GLP-1 (glucagon-like peptide 1) agonist or placebo.

The findings add to those already presented in June at the annual scientific sessions of the American Diabetes Association from the 6,068-patient trial, which enrolled patients with type 2 diabetes who had experienced an acute coronary syndrome within the past 6 months.

Other reassuring data on the safety of newer diabetes medicines came from an updated analysis of TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin [Januvia]). The time to first hospitalization for heart failure did not differ between the placebo and sitagliptin arms, and there were no differences between the treatments in terms of hospitalization for heart failure or cardiovascular death or hospitalization for heart failure or all-cause death with the DPP-4 (dipeptyl peptidase 4) inhibitor. TECOS enrolled nearly 15,000 patients with type 2 diabetes and concurrent cardiovascular disease who were aged 50 years or older and the primary findings have been published (N Engl J Med. 2015 July 15;373:232-42).

These trials provide accumulating evidence that there is no heart failure risk with these particular diabetes medications, Dr. Lars Rydén, professor of cardiology at the Karolinska Institute in Stockholm, commented in an interview at the annual congress of the European Society of Cardiology. Dr. Rydén added that the trial results everyone is waiting to hear about concern the cardiovascular safety of the selective sodium–glucose cotransporter-2 (SGLT-2) inhibitor empagliflozin (Jardiance).

Advance information issued by manufacturer Boehringer-Ingelheim suggests that this drug actually may lower cardiovascular risk in patients at high risk for cardiovascular events, Dr. Rydén observed. “Now, if that is true, it is the only modern glucose-lowering drug to have shown such a capacity.” Results of the EMPA-REG OUTCOME study will be presented in September at the annual meeting of the European Association for the Study of Diabetes in Stockholm.

LONDON – Neither the GLP-1 receptor agonist lixisenatide nor the DPP-4 inhibitor sitagliptin significantly increased the risk of heart failure or associated hospitalizations in patients with type 2 diabetes, according to data from two large cardiovascular safety trials.

Further analysis from ELIXA (Evaluation of Lixisenatide [Lyxumia] in Acute Coronary Syndrome) showed that the hazard ratios for several secondary heart failure endpoints were 1.00 or below. Although the risk for heart failure hospitalization was found to be nine times higher in patients who had a prior history of heart failure than in those who did not, there was there was no difference between treatment with the GLP-1 (glucagon-like peptide 1) agonist or placebo.

The findings add to those already presented in June at the annual scientific sessions of the American Diabetes Association from the 6,068-patient trial, which enrolled patients with type 2 diabetes who had experienced an acute coronary syndrome within the past 6 months.

Other reassuring data on the safety of newer diabetes medicines came from an updated analysis of TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin [Januvia]). The time to first hospitalization for heart failure did not differ between the placebo and sitagliptin arms, and there were no differences between the treatments in terms of hospitalization for heart failure or cardiovascular death or hospitalization for heart failure or all-cause death with the DPP-4 (dipeptyl peptidase 4) inhibitor. TECOS enrolled nearly 15,000 patients with type 2 diabetes and concurrent cardiovascular disease who were aged 50 years or older and the primary findings have been published (N Engl J Med. 2015 July 15;373:232-42).

These trials provide accumulating evidence that there is no heart failure risk with these particular diabetes medications, Dr. Lars Rydén, professor of cardiology at the Karolinska Institute in Stockholm, commented in an interview at the annual congress of the European Society of Cardiology. Dr. Rydén added that the trial results everyone is waiting to hear about concern the cardiovascular safety of the selective sodium–glucose cotransporter-2 (SGLT-2) inhibitor empagliflozin (Jardiance).

Advance information issued by manufacturer Boehringer-Ingelheim suggests that this drug actually may lower cardiovascular risk in patients at high risk for cardiovascular events, Dr. Rydén observed. “Now, if that is true, it is the only modern glucose-lowering drug to have shown such a capacity.” Results of the EMPA-REG OUTCOME study will be presented in September at the annual meeting of the European Association for the Study of Diabetes in Stockholm.

LONDON – The positive findings of the Biomarkers in Acute Cardiovascular Care (BACC) study reinforce a key change contained in the brand-new European Society of Cardiology guidelines for management of patients with acute coronary syndrome without ST-segment elevation: namely, that it’s appropriate to assess such patients using two measurements of a validated high-sensitivity cardiac troponin assay taken just 1 hour apart, according to Dr. Kurt Huber.

The BACC results are the evidence-based icing on the cake in support of the new recommendation in the guidelines, released at the annual congress of the European Society of Cardiology. The BACC study, which included 1,045 patients who presented to a university emergency department with acute chest pain suggestive of an acute coronary syndrome without ST-segment elevation, was the latest of several studies to show that most such patients can either be safely sent home from the ED or ruled-in for acute MI in just 1 hour when evaluated using a high-sensitivity troponin assay backed by a validated patient-management algorithm. The result means reduced pressure on overcrowded EDs and less patient anxiety because of delayed diagnosis, Dr. Huber, director of cardiology and emergency medicine at Wilhelminen Hospital in Vienna, observed during an interview at the meeting.

The BACC study, presented by Dr. Dirk Westermann of the University Heart Center Hamburg (Germany), utilized a high-sensitivity cardiac troponin I assay. The 1-hour algorithm had a 99.7% negative predictive value for acute MI. A total of 53% of patients were ruled out or in for MI at the 1-hour mark; the rest required further evaluation.

[email protected]

LONDON – The positive findings of the Biomarkers in Acute Cardiovascular Care (BACC) study reinforce a key change contained in the brand-new European Society of Cardiology guidelines for management of patients with acute coronary syndrome without ST-segment elevation: namely, that it’s appropriate to assess such patients using two measurements of a validated high-sensitivity cardiac troponin assay taken just 1 hour apart, according to Dr. Kurt Huber.

The BACC results are the evidence-based icing on the cake in support of the new recommendation in the guidelines, released at the annual congress of the European Society of Cardiology. The BACC study, which included 1,045 patients who presented to a university emergency department with acute chest pain suggestive of an acute coronary syndrome without ST-segment elevation, was the latest of several studies to show that most such patients can either be safely sent home from the ED or ruled-in for acute MI in just 1 hour when evaluated using a high-sensitivity troponin assay backed by a validated patient-management algorithm. The result means reduced pressure on overcrowded EDs and less patient anxiety because of delayed diagnosis, Dr. Huber, director of cardiology and emergency medicine at Wilhelminen Hospital in Vienna, observed during an interview at the meeting.

The BACC study, presented by Dr. Dirk Westermann of the University Heart Center Hamburg (Germany), utilized a high-sensitivity cardiac troponin I assay. The 1-hour algorithm had a 99.7% negative predictive value for acute MI. A total of 53% of patients were ruled out or in for MI at the 1-hour mark; the rest required further evaluation.

[email protected]

LONDON – The positive findings of the Biomarkers in Acute Cardiovascular Care (BACC) study reinforce a key change contained in the brand-new European Society of Cardiology guidelines for management of patients with acute coronary syndrome without ST-segment elevation: namely, that it’s appropriate to assess such patients using two measurements of a validated high-sensitivity cardiac troponin assay taken just 1 hour apart, according to Dr. Kurt Huber.

The BACC results are the evidence-based icing on the cake in support of the new recommendation in the guidelines, released at the annual congress of the European Society of Cardiology. The BACC study, which included 1,045 patients who presented to a university emergency department with acute chest pain suggestive of an acute coronary syndrome without ST-segment elevation, was the latest of several studies to show that most such patients can either be safely sent home from the ED or ruled-in for acute MI in just 1 hour when evaluated using a high-sensitivity troponin assay backed by a validated patient-management algorithm. The result means reduced pressure on overcrowded EDs and less patient anxiety because of delayed diagnosis, Dr. Huber, director of cardiology and emergency medicine at Wilhelminen Hospital in Vienna, observed during an interview at the meeting.

The BACC study, presented by Dr. Dirk Westermann of the University Heart Center Hamburg (Germany), utilized a high-sensitivity cardiac troponin I assay. The 1-hour algorithm had a 99.7% negative predictive value for acute MI. A total of 53% of patients were ruled out or in for MI at the 1-hour mark; the rest required further evaluation.

[email protected]

LONDON – U.S. patients hospitalized for heart failure and treated with antibiotics during their hospital stay had an increased rate both for developing Clostridium difficile infection and dying from it, based on nationwide data collected from nearly six million patients.

“Heart failure was an independent risk factor” in multivariate analyses that controlled for demographic factors as well as for several comorbidities of heart failure, Dr. Petra Mamic said in a video interview at the annual congress of the European Society of Cardiology.

She and her associates used data collected by the National Inpatient Sample during 2012 in more than 5.8 million U.S. hospitalized patients who received antibiotic treatment for a urinary tract infection, pneumonia, or sepsis. They compared the rate of subsequent infection with C. difficile in the roughly 1.4 million of these patients who had heart failure and the nearly 4.5 million without heart failure. In a multivariate analysis heart failure patients were 13% more likely to develop C. difficile infection compared with patients without heart failure. In a second multivariate analysis that focused just on patients with heart failure those who had become infected by C. difficile were 81% more likely to die in hospital compared with heart failure patients without this type of infection.

“Heart failure patients are frequently hospitalized and have a lot of bacterial infections, and so receive treatment with a lot of antibiotics,” said Dr. Mamic, an internal medicine physician at Stanford (Calif.) University. “What is important is that C. difficile infection is preventable. Our ultimate goal is to prevent C. difficile in these patients who have such high morbidity and mortality,”

Dr. Mamic had no disclosures.

[email protected]

On Twitter @mitchelzoler

LONDON – U.S. patients hospitalized for heart failure and treated with antibiotics during their hospital stay had an increased rate both for developing Clostridium difficile infection and dying from it, based on nationwide data collected from nearly six million patients.

“Heart failure was an independent risk factor” in multivariate analyses that controlled for demographic factors as well as for several comorbidities of heart failure, Dr. Petra Mamic said in a video interview at the annual congress of the European Society of Cardiology.

She and her associates used data collected by the National Inpatient Sample during 2012 in more than 5.8 million U.S. hospitalized patients who received antibiotic treatment for a urinary tract infection, pneumonia, or sepsis. They compared the rate of subsequent infection with C. difficile in the roughly 1.4 million of these patients who had heart failure and the nearly 4.5 million without heart failure. In a multivariate analysis heart failure patients were 13% more likely to develop C. difficile infection compared with patients without heart failure. In a second multivariate analysis that focused just on patients with heart failure those who had become infected by C. difficile were 81% more likely to die in hospital compared with heart failure patients without this type of infection.

“Heart failure patients are frequently hospitalized and have a lot of bacterial infections, and so receive treatment with a lot of antibiotics,” said Dr. Mamic, an internal medicine physician at Stanford (Calif.) University. “What is important is that C. difficile infection is preventable. Our ultimate goal is to prevent C. difficile in these patients who have such high morbidity and mortality,”

Dr. Mamic had no disclosures.

[email protected]

On Twitter @mitchelzoler

LONDON – U.S. patients hospitalized for heart failure and treated with antibiotics during their hospital stay had an increased rate both for developing Clostridium difficile infection and dying from it, based on nationwide data collected from nearly six million patients.

“Heart failure was an independent risk factor” in multivariate analyses that controlled for demographic factors as well as for several comorbidities of heart failure, Dr. Petra Mamic said in a video interview at the annual congress of the European Society of Cardiology.

She and her associates used data collected by the National Inpatient Sample during 2012 in more than 5.8 million U.S. hospitalized patients who received antibiotic treatment for a urinary tract infection, pneumonia, or sepsis. They compared the rate of subsequent infection with C. difficile in the roughly 1.4 million of these patients who had heart failure and the nearly 4.5 million without heart failure. In a multivariate analysis heart failure patients were 13% more likely to develop C. difficile infection compared with patients without heart failure. In a second multivariate analysis that focused just on patients with heart failure those who had become infected by C. difficile were 81% more likely to die in hospital compared with heart failure patients without this type of infection.

“Heart failure patients are frequently hospitalized and have a lot of bacterial infections, and so receive treatment with a lot of antibiotics,” said Dr. Mamic, an internal medicine physician at Stanford (Calif.) University. “What is important is that C. difficile infection is preventable. Our ultimate goal is to prevent C. difficile in these patients who have such high morbidity and mortality,”

Dr. Mamic had no disclosures.

[email protected]

On Twitter @mitchelzoler

LONDON – Drinking more than three cups of coffee daily increased the risk of a cardiovascular event by 50% in a study of more than 1,000 adults aged 45 years or younger with mild, untreated hypertension.

The results of the Hypertension and Ambulatory Recording Venetia Study (HARVEST) also showed that even moderate coffee intake, defined as between one and three cups per day, could up the risk of a cardiovascular event when compared with non–coffee drinkers.

“Don’t drink a lot of coffee; reduce your intake,” Dr. Lucio Mos advised young to middle-aged hypertensive adults in a video interview at the annual congress of the European Society of Cardiology.

Heavy coffee drinking is a strong predictor of increasing blood pressure and rising blood glucose, said Dr. Mos of Hospital San Daniele del Friuli in Udine, Italy. In this study, which had a mean of 12.5 years of follow-up, there was a linear relationship between coffee intake and cardiovascular events such as heart attacks, with the risk increasing with higher coffee intake.

LONDON – Drinking more than three cups of coffee daily increased the risk of a cardiovascular event by 50% in a study of more than 1,000 adults aged 45 years or younger with mild, untreated hypertension.

The results of the Hypertension and Ambulatory Recording Venetia Study (HARVEST) also showed that even moderate coffee intake, defined as between one and three cups per day, could up the risk of a cardiovascular event when compared with non–coffee drinkers.

“Don’t drink a lot of coffee; reduce your intake,” Dr. Lucio Mos advised young to middle-aged hypertensive adults in a video interview at the annual congress of the European Society of Cardiology.

Heavy coffee drinking is a strong predictor of increasing blood pressure and rising blood glucose, said Dr. Mos of Hospital San Daniele del Friuli in Udine, Italy. In this study, which had a mean of 12.5 years of follow-up, there was a linear relationship between coffee intake and cardiovascular events such as heart attacks, with the risk increasing with higher coffee intake.

LONDON – Drinking more than three cups of coffee daily increased the risk of a cardiovascular event by 50% in a study of more than 1,000 adults aged 45 years or younger with mild, untreated hypertension.

The results of the Hypertension and Ambulatory Recording Venetia Study (HARVEST) also showed that even moderate coffee intake, defined as between one and three cups per day, could up the risk of a cardiovascular event when compared with non–coffee drinkers.

“Don’t drink a lot of coffee; reduce your intake,” Dr. Lucio Mos advised young to middle-aged hypertensive adults in a video interview at the annual congress of the European Society of Cardiology.

Heavy coffee drinking is a strong predictor of increasing blood pressure and rising blood glucose, said Dr. Mos of Hospital San Daniele del Friuli in Udine, Italy. In this study, which had a mean of 12.5 years of follow-up, there was a linear relationship between coffee intake and cardiovascular events such as heart attacks, with the risk increasing with higher coffee intake.

LONDON – A regular midday nap is associated with clinically meaningful reductions in blood pressure in hypertensive patients, according to a prospective observational study presented at the annual congress of the European Society of Cardiology.

The midday nappers in the 386-patient study averaged 5 mm Hg lower daytime and 8 mm Hg lower nighttime systolic blood pressure, compared with non-nappers, Dr. Manolis Kallistratos said in a video interview.

Sleep during nap time was associated with bigger blood pressure reductions than simply resting. Sawing logs for 60 minutes or more brought the most benefits, according to Dr. Kallistratos, head of the hypertension division at Asklepieion Voula General Hospital in Athens.

Nappers also had significantly less arterial stiffness as reflected in a lower pulse wave velocity, as well as a smaller average left atrial diameter indicative of less structural heart damage, the cardiologist noted.

[email protected]

LONDON – A regular midday nap is associated with clinically meaningful reductions in blood pressure in hypertensive patients, according to a prospective observational study presented at the annual congress of the European Society of Cardiology.

The midday nappers in the 386-patient study averaged 5 mm Hg lower daytime and 8 mm Hg lower nighttime systolic blood pressure, compared with non-nappers, Dr. Manolis Kallistratos said in a video interview.

Sleep during nap time was associated with bigger blood pressure reductions than simply resting. Sawing logs for 60 minutes or more brought the most benefits, according to Dr. Kallistratos, head of the hypertension division at Asklepieion Voula General Hospital in Athens.

Nappers also had significantly less arterial stiffness as reflected in a lower pulse wave velocity, as well as a smaller average left atrial diameter indicative of less structural heart damage, the cardiologist noted.

[email protected]

LONDON – A regular midday nap is associated with clinically meaningful reductions in blood pressure in hypertensive patients, according to a prospective observational study presented at the annual congress of the European Society of Cardiology.

The midday nappers in the 386-patient study averaged 5 mm Hg lower daytime and 8 mm Hg lower nighttime systolic blood pressure, compared with non-nappers, Dr. Manolis Kallistratos said in a video interview.

Sleep during nap time was associated with bigger blood pressure reductions than simply resting. Sawing logs for 60 minutes or more brought the most benefits, according to Dr. Kallistratos, head of the hypertension division at Asklepieion Voula General Hospital in Athens.

Nappers also had significantly less arterial stiffness as reflected in a lower pulse wave velocity, as well as a smaller average left atrial diameter indicative of less structural heart damage, the cardiologist noted.

[email protected]

Urinary incontinence is a troubling yet common effect of radical prostatectomy, affecting 4% to 87% of patients. The impact of urinary incontinence can reach far beyond the physical discomforts of skin irritation, physical activity restrictions, and adverse drug events: The economic impact caused by the purchasing of management supplies, diagnostic and treatment procedures, and long-term care add to the psychological concerns centered around embarrassment, guilt, and frustration.

John P. Lavelle, MBCHB, notes that too many patients adhere to “avoidance therapy,” pleased that they no longer have prostate cancer but trying their best to manage the urinary leakage on their own by wearing an absorbent pad and hiding from society. Regrettably, physicians also tend to practice avoidance therapy. “A lot of people don’t want to talk about [incontinence], but I think it’s important to bring the thing up correctly to the patient,” instructed Dr. Lavelle. “Assume that they have it, and if they tell you that they don’t, that’s great.”

Urinary incontinence is a troubling yet common effect of radical prostatectomy, affecting 4% to 87% of patients. The impact of urinary incontinence can reach far beyond the physical discomforts of skin irritation, physical activity restrictions, and adverse drug events: The economic impact caused by the purchasing of management supplies, diagnostic and treatment procedures, and long-term care add to the psychological concerns centered around embarrassment, guilt, and frustration.

John P. Lavelle, MBCHB, notes that too many patients adhere to “avoidance therapy,” pleased that they no longer have prostate cancer but trying their best to manage the urinary leakage on their own by wearing an absorbent pad and hiding from society. Regrettably, physicians also tend to practice avoidance therapy. “A lot of people don’t want to talk about [incontinence], but I think it’s important to bring the thing up correctly to the patient,” instructed Dr. Lavelle. “Assume that they have it, and if they tell you that they don’t, that’s great.”

Urinary incontinence is a troubling yet common effect of radical prostatectomy, affecting 4% to 87% of patients. The impact of urinary incontinence can reach far beyond the physical discomforts of skin irritation, physical activity restrictions, and adverse drug events: The economic impact caused by the purchasing of management supplies, diagnostic and treatment procedures, and long-term care add to the psychological concerns centered around embarrassment, guilt, and frustration.

John P. Lavelle, MBCHB, notes that too many patients adhere to “avoidance therapy,” pleased that they no longer have prostate cancer but trying their best to manage the urinary leakage on their own by wearing an absorbent pad and hiding from society. Regrettably, physicians also tend to practice avoidance therapy. “A lot of people don’t want to talk about [incontinence], but I think it’s important to bring the thing up correctly to the patient,” instructed Dr. Lavelle. “Assume that they have it, and if they tell you that they don’t, that’s great.”