Incontinence after Prostate Treatment: AUA/SUFU Guideline

Abstract

Purpose: Urinary incontinence after prostate treatment (IPT) is one of the few urologic diseases that is iatrogenic, and, therefore, predictable and perhaps preventable. Evaluation of the incontinent patient, risk factors for IPT, the assessment of the patient prior to intervention, and a stepwise approach to management are covered in this guideline. Algorithms for patient evaluation, surgical management, and device failure are also provided. Materials and Methods: This guideline was developed using a systematic review from the Mayo Clinic Evidence Based Practice Center with additional supplementation by the authors. A research librarian conducted searches from 2000 to December 21 st , 2017 using Ovid, MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Databases of Systematic Reviews. Additional references through 12/31/2018 were identified. Results: This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with IPT and the safe and effective management of the condition in both surgical and non-surgical contexts. Statements guiding the clinician on proper management of device failure are also included. Conclusion:Most patients who undergo radical prostatectomy (RP), and some patients who undergo radiation therapy (RT) or surgery for benign prostatic hyperplasia (BPH), will experience IPT. Although non-surgical options, such as pelvic floor muscle exercises (PFME), can hasten continence recovery, patients who remain incontinent at one-year post-procedure, or have severe incontinence at six months, may elect to undergo surgical treatment (e.g. artificial urinary sphincter). Prior to IPT surgery, the risks, benefits, alternatives, and additional likely procedures should be discussed with the patient.

Evaluation and treatment of urinary incontinence in the aging male

“…Iatrogenic UI may result after prostate surgery for benign prostatic hyperplasia (BPH) or prostate cancer. The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) published guidelines in 2019 addressing incontinence after prostate treatment (IPT) [25]. IPT refers to those with incontinence after radical prostatectomy, radiation treatment, and/ or treatment of benign prostatic hyperplasia (BPH).…”

“…Although cystourethroscopy is not necessary in the initial workup of the uncomplicated patient with OAB, it may provide useful information for the aging male with UI [9]. Cystourethroscopy allows one to assess prostate size and shape if UI is thought to be secondary to chronic BOO, as well as degree of bladder trabeculation which may suggest outlet resistance [25,54]. Cystourethroscopy is also recommended prior to surgical intervention for SUI to assess for urethral and bladder pathology that may affect surgical outcomes [25].…”

“…Cystourethroscopy allows one to assess prostate size and shape if UI is thought to be secondary to chronic BOO, as well as degree of bladder trabeculation which may suggest outlet resistance [25,54]. Cystourethroscopy is also recommended prior to surgical intervention for SUI to assess for urethral and bladder pathology that may affect surgical outcomes [25]. Figure 3 summarizes additional testing that may be considered as part of the evaluation.…”

Incontinence, physical activity, and pelvic floor muscle training in female pelvic cancer survivors after radiotherapy

“…To feel safe enough to be physically more active, the survivors probably need targeted intervention support to help them reduce incontinence of feces and urine. For prostate cancer survivors, in contrast, there is an organized focus on support and education to help patients with UI in order to maintain QoL and increase physical activity levels (121,122). However, an organized focus on support and education, such as that seen in prostate cancer rehabilitation, is lacking for many female PCS.…”

Artificial Urinary Sphincter for Postradical Prostatectomy Urinary Incontinence — Is It the Best Option?

“…Most experienced urologists concur that an appropriate choice of patient is key to favorable MS outcomes [12]. The most appropriate patients have mild-to-moderate SUI and competent residual sphincter function, which permits sufficient detrusor contraction to overwhelm the fixed sling impediment and allow voiding [13]. Given the option between MS and AUS, most PPI patients choose lesser invasive MS rather than AUS [14].…”