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BackTable / Urology / Topic / Condition
Post-Prostatectomy Incontinence
Urinary incontinence may occur in males after a radical prostatectomy procedure. Post radical prostatectomy urinary incontinence is a common morbidity resulting from the surgery. A number of control mechanisms for urinary continence, as well as the proximal urethral sphincter, are lost during radical prostatectomy. Postoperatively, urinary continence relies on the rhabdosphincter which is at high risk for damage during radical prostatectomy. Post-prostatectomy incontinence may occur from urethral causes or detrusor causes. While the precise etiology of post-prostatectomy incontinence is unclear, intraoperative damage of nerves and sphincter and bladder neck dysfunction may cause this condition.
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Post-Prostatectomy Incontinence Diagnosis
Initial clinical assessment for post-prostatectomy incontinence should include a medical history and physical exam. A rectal and sacral neurological exam, urine analysis, and ultrasound for urine residue should be performed. Additionally, a urinary diary and incontinence questionnaire, such as the International Consultation on Incontinence Questionnaire (ICIQ-SF), are utilized to diagnose post-prostatectomy incontinence. Urethrocystoscopy can be performed for further evaluation of the sphincter and anastomosis region if first line treatments fail.
Post-Prostatectomy Incontinence Podcasts
Listen to leading physicians discuss post-prostatectomy incontinence on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Episode #11
Dr. Aditya Bagrodia interviews urologist Dr. Steve Hudak from UT Southwestern Medical Center about post-prostatectomy incontinence. They cover an array of topics including, incontinence evaluation, managing patient expectations, kegel exercises and pelvic floor therapy, and slings vs. artificial urinary sphincters.
Post-Prostatectomy Incontinence Treatment
The most widely recommended non-invasive treatment for post-prostatectomy incontinence is pelvic floor muscle training. Duloxetine, a serotonin norepinephrine reuptake inhibitor, may be used in combination with pelvic floor muscle training, but is not proven to cure male incontinence post-prostatectomy. Behavioral therapies include bladder training, timed voiding, reduction of bladder irritants and fluid intake. If conservative therapies fail, surgical interventions such as artificial urinary sphincters or fixed and adjustable slings are recommended.
References
[1] Bauer, R. M., Bastian, P. J., Gozzi, C., & Stief, C. G. (2008, October 23). Postprostatectomy incontinence: All about diagnosis and management. European Urology. Retrieved February 20, 2022, from https://www.sciencedirect.com/science/article/pii/S0302283808012463
[2] Hoyland, K., Vasdev, N., Abrof, A., & Boustead, G. (2014). Post-radical prostatectomy incontinence: Etiology and prevention. Reviews in urology. Retrieved February 20, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274175/
[3] Rahnama'i, M. S., Marcelissen, T., Geavlete, B., Tutolo, M., & Hüsch, T. (2021, April 9). Current management of post-radical prostatectomy urinary incontinence. Frontiers in surgery. Retrieved February 20, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063855/
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Vanita Gaglani, RPT
Dr. Steve Hudak