The risk of suffering from urine leakage after prostate surgery is not higher if the surgeon is inexperienced, according to a new Swedish study.
The proportion of urinary leakage varied between 0 and 40% for each individual surgeon.
Surgical skill are probably more important for incontinence than surgeon volume.
Perhaps different in the US.
"Surgeons with higher volumes had significantly better functional preservation than those with lower volumes (p = 0.005). For a patient with the mean level of all covariates, the predicted probability of experiencing recovery of both erectile and urinary function at 1 yr was 21% if treated by a surgeon with an annual volume of 25 cases; this probability increased to 47% if the surgeon had an annual volume of 100."
ncbi.nlm.nih.gov/pmc/articl...
Maybe availability and access to data differs? Do you in US have patient-reported functional outcomes in questionnaires from independent third party, that can be used for benchmarking between surgeons?
That only happens at top institutions (like MSK) or when there are studies done. I'd like to see it be done as part of routine practice. Urologists often have no clue what the functional outcomes are because patients don't tell them. It is particularly a problem for sexual function.
I can't EVER remember seeing a study showing high-volume surgical departments didn't have superior metrics for ANY type of surgery.
The heterogeneity in results between individual surgeons at the same department is never revealed. 0% vs. 40% incontinence between two individual surgeons with the same total volume is remarkable.
Of course. There used to be a freely-available website with evaluation of multiple surgeon metrics--complication rates, procedure volume, etc. That seems to have gone away, but there are sites that compile this information, on a subscription basis. It's not foolproof of course. Some surgeons get rated badly because they suck; others have higher complication rates because they are known to take on the most difficult cases. So sure, you have to use your critical thinking skills to evaluate these numbers. I have not myself subscribed to this one, for what it's worth:
"The risk of suffering from urine leakage after prostate surgery is not higher if the surgeon is inexperienced, according to a new Swedish study."
Makes no sense.
How are they measuring it and how reliably are they measuring it?
In the US they always think they are doing better than they are. That effect exists in Sweden even more so It seems.
A total of 8326 men underwent robot-assisted radical prostatectomy (RARP) between 2017 and 2019. All men answered a questionnaire one year after RARP. 14% (659/4 668) of the men were incontinent one year after RARP. There was no statistically significant association between surgeon volume and incontinence. The best surgeon had 0% incontinence, the the worst surgeon had 40% incontinence. Skill and talent played a bigger role than expected!
Repetition is the mother of skill... Period!
That is all!
Best Regards
Skill and talent may be more decisive than number of operations.
Talent may get you in the door, but repetition is undeniably the mother of skill. Skill only comes with the completion of numerous repetition. This is true in many different human physical function. Do you want to debate an Olympic Athlete?
You'll find the greatest number of repetitive operations performed at Major Cancer Center's, where local facilities and doctors cannot compete. There was a studiy completed on this very thing... Which contradicts the OP and has sunstansive supporting data.
Good Luck
That is one of the questions we asked our surgeon in our interview of him. If they dont know their exact % right after surgery and at one year on this and other functions, run the other way.
Minor set back with incontinence after initial period of 99% continence.
Surgeons in Idaho
After surgery ongoing urology care
Incontinence Frustration
