Management of post-prostatectomy urinary incontinence

Author(s): S. I. Rahman - Pages: 44–48

Abstract

Post-prostatectomy urinary incontinence (PPUI) can be a devastating complication of this form of surgery. Urinary incontinence is more common after a radical prostatectomy for cancer than following a simple prostatectomy or transurethral resection of the prostate for benign prostatic enlargement. The majority of patients do recover continence, although this may take up to 2 years. Only a minority require surgical interventions. This condition can manifest as stress, urge, functional, overflow or mixed UI. Treatment should commence as soon as the problem is recognized. The aim is to help patients achieve total continence so that they can regain their confidence and self-esteem, and benefit from an improvement in their quality of life. No one should have to suffer from PPUI since the currently available treatment options are highly efficacious. All patients should receive comprehensive counselling. Conservative therapy is highly effective, and pelvic floor muscle exercises are possibly the single most important treatment modality. Lifestyle advice and medication also play important roles. Non-conservative forms of management include injections, balloon compressions, slings and artificial urinary sphincters. The artificial urinary sphincter is the most effective and time-tested treatment for moderately severe and severe cases of UI, and the male sling is increasingly being recognized as an effective modality for mild to moderate degrees of stress UI. Future treatments should focus on minimally invasive and highly efficacious modalities.

Keywords: conservative treatment, interventional management, post-prostatectomy urinary incontinence.