New Modalities in Treatment of Post Retropubic Radical Prostatectomy Incontinence

Abstract

P ost prostatectomy voiding dysfunction especially PPI is one of the most important and devastating complication for both the patient and the surgeon. Regardless the type of prostatectomy, or the nature of the prostate disease, several risk factors are common to all and they include preexisting detrusor and sphincteric dysfunction, increasing age, and surgical expertise. Evaluation of post-prostatectomy voiding dysfunction needs a complete history taking, complete physical examination and Pad testing. Also a list of important investigations to reach the possible etiology and it includes: Urinalysis, BUN, serum creatinine, Uroflowmetry, Urodynamic study, Cystourethrography, and Endoscopy. However, the recommendations for treatment options are still only given generally without a clear association with stage and severity of incontinence or retention. This limitation can only be overcome in the future if sufficient evidence is provided by future clinical studies. Moreover, there’s no single precise definition for incontinence, therefore a comparison of study results is often not possible. For early post-prostatectomy incontinence, noninvasive therapies like PFMT, biofeedback, and electrical stimulation are in general strongly recommended although there is no strong data to support these recommendations. In addition, there is no conclusive data concerning the optimal timing to begin treatment—specifically for preoperative versus postoperative—noninvasive therapy. Regarding the pharmacological treatment as a part of non-invasive therapy: The efficacy of these drugs in men has also been evaluated. Despite the efficacy shown these drugs have not yet received approval for treatment of male stress incontinence. If noninvasive therapy fails, surgical options are recommended, but the natural healing rate should be taken into account. Only in severe incontinence should surgical therapy be considered before 6 months to 12 months after radical prostatectomy. For severe or persistent incontinence the artificial urinary sphincter is still the gold standard of treatment. Continence and high patient satisfaction rates are currently the reference treatment for refractory sphincter incompetence in men.