Incontinence and Erectile Dysfunction Following Radical Prostatectomy: A Review

Abstract

Radical prostatectomy remains the treatment of choice for localized prostate cancer in age-appropriate and health-appropriate men. Although cancer control is the most important aspect of a radical prostatectomy, minimization of postoperative morbidity, especially urinary incontinence and erectile dysfunction, is becoming a greater concern. We reviewed recent data available on Medline regarding the incidence, pathophysiology, evaluation, and treatment of incontinence and sexual dysfunction after radical prostatectomy. Health-related quality of life issues have been specifically addressed. Although low incidences of incontinence and erectile dysfunction after radical prostatectomy have been reported in the hands of experienced surgeons, the literature review revealed a great variety, with incontinence rates ranging from 0.3–65.6% and potency rates ranging from 11–87%. Several factors contribute to this wide difference, the most important being the application of a meticulous surgical technique. General and cancer-specific health-related quality of life is not being affected after radical prostatectomy. The incidence of incontinence and erectile dysfunction is higher after radical prostatectomy when compared to the incidence observed when other therapies for localized prostate cancer are applied. However, the majority of the patients undergoing radical prostatectomy would vote for the operation again. Today, avoidance of major complications after radical prostatectomy depends mostly on a high-quality surgical technique. When incontinence or erectile dysfunction persists after radical prostatectomy, the majority of the treated patients can be managed effectively by various methods.

Validation of quality indicators for radical prostatectomy

“…21 Such an approach would address the data quality issues accounting for the wide variability in late morbidity rates in the literature. 3,4,35,38,[60][61][62] It was feasible to assess acute surgical complications in our chart review, supporting the conclusion reached by Miller et al…”

“…Furthermore, because incontinence and erectile dysfunction are considered very important outcomes of prostate surgery and reflect quality of surgical care, 2,35,60,61,[70][71][72][73] we strongly advocate that bodies responsible for cancer care quality consider moving towards widespread application of a validated survey instrument to evaluate these indicators in a proactive and prospective manner.…”

“…Our findings suggest that following further investigation, the use of nerve-sparing surgery could become a useful surrogate quality indicator for evaluating the presence of late morbidities because the use of this technique has been shown to increase the recovery of continence and erectile function after radical prostatectomy. 2,23,35,60,61,[70][71][72][73] In this study, we did not analyze individual surgeon volume, as that data was unavailable to us. However, most studies examining adverse outcomes following cancer surgery have focused on hospital volume, as a proxy for surgeon volume, although high hospital volume could very well be spread among a number of low volume surgeons.…”

Évaluation de la fonction érectile et de la continence urinaire après prostatectomie radicale à l’hôpital général de Grand-Yoff

“…Il s'y ajoute les troubles occasionnés par le déficit androgénique lié à l'âge ainsi que les troubles urinaires du bas appareil associés à la maladie prostatique. Une revue de la littérature fait état d'un taux de DE postopératoire variant de 11 à 87 % [10]. Cette disparité des chiffres s'expliquerait par l'existence d'une multitude de paramètres interactifs qui lient le cancer de la prostate à la sexualité.…”

Adverse events of injectables, what kind of jet-skiers should be informed about serious vaginal injury, and what Kant thinks about it

“…Bulking agents have also been used off-label for the treatment of stress urinary incontinence in men, especially after radical retropubic prostatectomy in which incontinence varies from 2.5% to 87% [3,4].…”