Korean J Urol.  2012 Aug;53(8):511-518.

Current Trends in the Management of Post-Prostatectomy Incontinence

• Kim JC
• Cho KJ

Abstract

One of the annoying complications of radical prostatectomy is urinary incontinence. Post-prostatectomy incontinence (PPI) causes a significant impact on the patient's health-related quality of life. Although PPI is stress urinary incontinence caused by intrinsic sphincter deficiency in most cases, bladder dysfunction and vesicourethral anastomotic stenosis can induce urine leakage also. Exact clinical assessments, such as a voiding diary, incontinence questionnaire, pad test, urodynamic study, and urethrocystoscopy, are necessary to determine adequate treatment. The initial management of PPI is conservative treatment including lifestyle interventions, pelvic floor muscle training with or without biofeedback, and bladder training. An early start of conservative treatment is recommended during the first year. If the conservative treatment fails, surgical treatment is recommended. Surgical treatment of stress urinary incontinence after radical prostatectomy can be divided into minimally invasive and invasive treatments. Minimally invasive treatment includes injection of urethral bulking agents, male suburethral sling, and adjustable continence balloons. Invasive treatment includes artificial urinary sphincter implantation, which is still the gold standard and the most effective treatment of PPI. However, the demand for minimally invasive treatment is increasing, and many urologists consider male suburethral slings to be an acceptable treatment for PPI. The male sling is usually recommended for patients with persistent mild or moderate incontinence. It is necessary to improve our understanding of the pathophysiologic mechanisms of PPI and to compare different procedures for the development of new and potentially better treatment options.

Keyword

Postoperative complications; Prostatectomy; Prostatic neoplasms; Urinary incontinence

MeSH Terms

Biofeedback, Psychology
Constriction, Pathologic
Humans
Life Style
Male
Muscles
Pelvic Floor
Postoperative Complications
Prostatectomy
Prostatic Neoplasms
Quality of Life
Suburethral Slings
Urinary Bladder
Urinary Incontinence
Urinary Sphincter, Artificial
Urodynamics

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