CURRENT MODALITIES IN MANAGEMENT OF POST-RADICAL PROSTATECTOMY INCONTINENCE

Abstract

Prostate cancer has become the most common non cutaneous malignancy in men. It can be managed according to its stages and grading by different modalities such as watchful waiting, active surveillance or surgical intervention in the form of radical prostatectomy. But in metastatic cases hormonal therapy, chemotherapy and radiation are the optimal treatment. There are different techniques for surgical management of cancer prostate include retro pubic radical prostatectomy, laparoscopic or robotic assisted radical prostatectomy. Complications have developed from retro pubic radical prostatectomy that strongly affect the patient`s quality of life such as rectal injury, urethral injury, obturator nerve injury, recto urinary fistula, urethral stricture, bladder neck contracture, erectile dysfunction and thromboembolic complication. Urinary incontinence is the most bothersome complication of radical prostatectomy. A lot of studies and researches have described the way of management of that complication. Conservative treatment is the first choice in dealing with the incontinence especially in the first year after the operation. Conservative management include pelvic floor muscle training, biofeedback therapy and electrical stimulation of the sacral reflex. Pharmacological therapy in the form of using Duloxetine, alpha adrenergic agonist, anticholinergic drugs and beta adrenergic agonist has increased the result of recovery. Injection therapy by using collagen, Teflon and macroplastique represent an era in managing the incontinence through creation of artificial cushions in urethra that improve urethral coaptation and restoring continence. Sling surgery is a way to suspense the urethra based on the concept of passive external urethral compression. Slings which are used vary from bone anchored system, trans obturator sling, adjustable retro pubic sling and autologous sling as using rectus fascia. Adjustable continence balloons (ProAct) are one of the most recent treatments in management of incontinence with a cost that is remarkable less than that of artificial sphincter. They depend in their action on compression of the urethra by two balloons located on either sides of the urethra.