Surgical treatment of post‐prostatectomy stress urinary incontinence in adult men: Report from the 6th International Consultation on Incontinence

Abstract

Aims:To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. Methods: The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Results: Voiding diary and pad tests are valuable for assessing quantity of leakage.Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI.Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. Conclusions: Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

“…Aging and comorbidities (eg, obesity) were previously associated with PPUI . Apart from the mechanical effect of increased pressure on the bladder and pelvic floor due to overweight, metabolic syndrome has also been linked to bladder dysfunction and poorer oncological outcomes, increasing the risk of PPUI . Other factors have been proposed and linked to sphincter dysfunction, including Gleason score, levator ani anatomy, membranous urethral length, MUCP, lower urinary tract symptoms, previous transurethral resection of the prostate, prostate volume, and sphincter volume .…”

“…9 Apart from the mechanical effect of increased pressure on the bladder and pelvic floor due to overweight, metabolic syndrome has also been linked to bladder dysfunction and poorer oncological outcomes, increasing the risk of PPUI. 4,10 Other factors have been proposed and linked to sphincter dysfunction, including Gleason score, levator ani anatomy, membranous urethral length, MUCP, lower urinary tract symptoms, previous transurethral resection of the prostate, prostate volume, and sphincter volume. 9,11,12 Retrospective analysis of patients undergoing RP has shown a correlation (r = 0.69, P < 0.01) between the retrograde leak point pressure and the use of incontinence pads; a similar correlation was found between the abdominal leak point pressure, MUCP, and pad use (r = 0.61, P < 0.01 and r = 0.64, P < 0.01, respectively).…”

“…Irrespective of controversies on surgical techniques, the etiology of postprostatectomy urinary incontinence (PPUI) after RP is multifactorial and relates to preoperative lower urinary tract function, operative technique, and altered anatomy . PPUI is associated with a negative impact on quality of life (QoL) and may affect up to 87% of patients, depending on several factors such as definition of urinary incontinence (UI), how it is measured, and duration of follow‐up …”

“…3 Irrespective of controversies on surgical techniques, the etiology of postprostatectomy urinary incontinence (PPUI) after RP is multifactorial and relates to preoperative lower urinary tract function, operative technique, and altered anatomy. 4 PPUI is associated with a negative impact on quality of life (QoL) and may affect up to 87% of patients, depending on several factors such as definition of urinary incontinence (UI), how it is measured, and duration of follow-up. 4 This is a consensus report of the proceedings of a Research Proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?"…”

“…4 PPUI is associated with a negative impact on quality of life (QoL) and may affect up to 87% of patients, depending on several factors such as definition of urinary incontinence (UI), how it is measured, and duration of follow-up. 4 This is a consensus report of the proceedings of a Research Proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" As papers' remit is on prevention, this review gives insights on patient selection, preoperative pelvic floor muscle exercise (PFME), peroperative measures and postoperative strategies.…”