Incontinence after radical prostatectomy: Anything new in its management?

Abstract

Introduction: With the increasing number of radical prostatectomies (RP) performed, male stress urinary incontinence (SUI) has become common. The artificial urinary sphincter (AUS) is the gold standard to treat SUI post-RP, but new devices have recently been developed. We review the recent studies on the treatment of SUI post-RP; we also describe the surgical techniques, mechanisms of action and results of these new procedures. Methods: We conducted a literature review search in the PubMed/ Medline and Embase databases. Our search was restricted to recent articles. We included studies even if the urinary incontinence was due to sphincter deficiency after RP in non-neurologic patients. Results: We found 8 cohort studies for the surgical procedure: 3 studies concerning slings, 1 involving balloons adjustable implant, and 4 involving new devices. The only randomized controlled trial (RCT) was a pharmacologic clinical trial comparing duloxetine to placebo. The social continence rates were analyzed for 6 studies and were up to 66%. Conclusion: New minimally invasive surgical procedures have emerged as the main alternative to AUS, with social continence rates up to 60% despite just 1 RCT studying the pharmacologic approach. There is an urgent need for well-designed clinical trials to clarify the role of new surgical alternatives in the management of SUI post-RP. New technologies should continue to be evaluated and compared with the AUS, which remains the gold standard.

Therapeutic Efficacy of a New Procedure for Male Urinary Incontinence Combining a Suburethral Polypropylene Mesh and Cardiovascular Patch

“…However, antimuscarinic agents are not useful in the treatment of male ISD. In case of refractory SUI after conservative treatment, invasive management is recommended [9]. …”

A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence

“…After initial work-up and characterization, management of PPI is mainly based on surgical therapies even if conservative solutions may be relevant in specific cases [1,10,13]. The aim of the present work was to present the most recent advances in these fields to describe a pragmatic approach to characterization and treatment of PPI in accordance with the current knowledge.…”

“…The Zephyr (Zephyr Surgical Implants, Geneva, Switzerland) device has been tested in a retrospective study and led to a 73% short-term rate of social continence (0 to 1 pad/day) [34]. Other devices have been presented in their preclinical phase of development, including remote controlled devices [10,35]. All need to be further evaluated, if possible through comparative trials to effectively challenge the AMS800 supremacy in the near future.…”

“…Adjustable sling devices have failed to demonstrate a good tolerability with a rather high rate of severe complications [10,47]. New slings such as the 4-arm Virtue male sling are about to be tested in clinical trials [48].…”

“…Furthermore, given the favorable oncologic results obtained after radical prostatectomy, functional outcomes (including urinary continence and sexual health) are obviously of utmost importance in this field [6 && ,7-9]. In the past few years, PPI cause and management has thus progressively been considered as a very hot topic [10,11].…”