Post-prostatectomy incontinence: Etiology, evaluation, and management

Abstract

Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.

Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial

“…Several different risk factors might have influenced UI after RP: preoperative detrusor condition, bladder outlet obstruction, UI before surgery, age, body mass index and some anatomical conditions such as the thickness of the pelvic diaphragm, the functional length of urethra or the prostate volume 3,9–13 ; intra-operative techniques such as bilateral neurovascular bundle sparing, bladder neck preservation or urethral suspension 3,14–16 and postoperative detrusor disfunction, reduced bladder compliance or intrinsic urethral sphincter deficiency 9,17–19 may also influence UI after RP.…”

Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success

“…The reported incidence of persistent post‐prostatectomy stress urinary incontinence (SUI) has remained consistent, despite the emergence of robotic‐assisted laparoscopic prostatectomy (RALP) . Several factors mediating the return to post‐prostatectomy continence have been studied, including baseline degree of SUI, history of pelvic radiation, and presence of vesicourethral anastomotic contracture .…”

Impact of Therapeutic Electrical Stimulation of Sacral Surface Considering Individual Anatomical Sacral Variations on Early Recovery Urinary Continence after Radical Prostatectomy

“…The difference of mean leakage weight between groups at different time of treatment shows the percent of continence in different groups at different time of treatment Pruritus (n) 3% (9) 2% (6) Nause (n) 6.8% (22) 5% (16) Respiratory depression (n) 0% (0) 0% (0) biofeedback, neuromodulation by either magnetic or electrical stimulation), the beneficial effect of these methods in managing the UI is debatable [8]- [15].…”

“…Numerous invasive and noninvasive treatment strategies are reported to manage PPI [8]- [15]. Noninvasive treatment predominantly includes physical exercise (i.e.…”

“…collagen injection, male sling and artificial urinary sphincter). Although surgical intervention is the treatment option for persistent and troublesome incontinence, it is typically delayed for at least one year following prostatectomy [15]. Within the first post-operative year of prostatectomy noninvasive methods are preferred.…”