Should Uterus Cancer Patients Be Screened For Preemptive Urinary Incontinence?

 The American Journal of Obstetrics and Gynecology has recently published an approved manuscript of a pilot study on relationship between cancer of uterus and stress urinary incontinence (SUI). The purpose of the study ‘Cancer of the Uterus and Treatment of Stress Incontinence: A Pilot Study’ was to dig out that whether women with early signs of endometrial cancer should be ruled out for SUI at their first visit to gynecologic oncologist or not. The results of study could help in establishing a proof for pre-emptive urogynecologist referral of endometrial cancer patients for concurrent treatment of endometrial cancer and SUI.

Katina Robinson, MD and her team carried out the pilot study on endometrial cancer and SUI and found that out of 59 endometrial cancer patients 39% were screened positive for SUI. Out of those 39%, 80% took urogynecologist referral and approximately 90% of them were diagnosed with SUI. The average age was 62y (range: 37-85) and average BMI was 38.1 (range: 25.2-55.8). The endometrial cancer stages in the study group varied from complex atypical hyperplasia without cancer, grade-1 histology, grade-2 histology, grade-3 endometrioid, papillary serous tumors and complex atypical hyperplasia. The study group underwent anti-incontinence concurrent surgery and non-surgical treatment. There were few patients of concurrent surgery who received chemotherapy and radiation therapy. To reach the conclusion, surgical and non-surgical treatments for SUI were presented on table.

In the US, endometrial cancer is the commonest gynecologic cancer, with an early diagnosis; the survival rate is 5 years in 95% of the patients. Over half of such patients have SUI and urine leakage on sneezing and coughing. Most of the endometrial cancer patients are treated with single surgery and similarly SUI patients are treated with the single surgery too. If concurrent surgery in endometrial cancer patients with SUI takes place, it will be a savior in multi-modal ways.

On having concurrent surgery, cancer surgery and SUI surgery at the same time will be feasible because;

  • Health care cost will be saved by saving the doctor visit copays, hospital sanitary pads etc.
  • Surgery time will be saved by avoiding one surgery. The concurrent surgery, average time required is 32 days (between first gynecologic oncology visits to surgery) and for single surgery, time required is average 22 days.
  • Medical risks can be minimized by eliminating second surgery’s anesthesia.

The pilot study conducted by Katina Robinson supported the pre-emptive screening of SUI in endometrial cancer patients. This will shun the chances of delay in the treatments. Dr Katina said that one question that screened women with SUI was, “Do you ever leak urine when you cough, sneeze, jump or laugh?” Dr Thomas SG concluded in his research that women with endometrial cancer often have high chances of SUI and it goes undiagnosed and that there is a close connection between symptoms of urinary incontinence and BMI/increased age. In pilot study conducted by Dr Katina Robinson, the average age was 60 and BMI was 38.1.

Though the study is significant in establishing the importance of pre-emptive screening of SUI in cancer patients, and helps in reducing the economic cost of several surgeries, but research has to go further, where there should be an evidence-based answers available regarding the effect on quality of life in women undergoing concurrent surgeries, the effect on clinical outcomes and the effects of their sexual lives.

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