Postprostatectomy Incontinence: All About Diagnosis and Management

• Published in: European urology 2009-02, Vol.55 (2), p.322-333
• Main Authors: Bauer, Ricarda M, Bastian, Patrick J, Gozzi, Christian, Stief, Christian G
• Format: Article
• Language: English
• Subjects: Artificial urinary sphincter; Biofeedback; Biofeedback, Psychology; Biological and medical sciences; Diagnosis; Duloxetine; Electric Stimulation Therapy; Electrical stimulation; Humans; Injection therapy; Male; Male incontinence; Massage; Medical sciences; Minimal invasive treatment; Muscle, Skeletal - physiopathology; Nephrology. Urinary tract diseases; Pelvic floor muscle training; Post prostatectomy Incontinence; Prostate cancer; Prostatectomy - adverse effects; Risk Factors; Sling; Stem cell therapy; Stem Cell Transplantation; Suburethral Slings; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urethra - physiopathology; Urinary Incontinence - epidemiology; Urinary Incontinence - etiology; Urinary Incontinence - prevention & control; Urinary Incontinence - surgery; Urinary Sphincter, Artificial; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; Wound Healing
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2008.10.029

Abstract Context The ever-increasing number of radical prostatectomies entails an increasing number of patients suffering from postprostatectomy stress incontinence despite improved surgical techniques. We provide an overview of the current diagnosis and treatment of postprostatectomy stress incontinence. Objective To review previous and recent literature on this subject and to assess the current standards of diagnosis and management of postprostatectomy incontinence. Evidence acquisition The PubMed database was searched, and all articles published since 2000 were evaluated. Evidence synthesis This review presents the current recommended diagnostic tools and available noninvasive and invasive treatment options. Conclusions The European Association of Urology (EAU) recommends a two-stage assessment for diagnosis of postprostatectomy incontinence. Noninvasive therapy, pelvic floor-muscle training and biofeedback, is recommended in early postoperative and mild incontinence. Pharmacological treatment with duloxetine is especially effective in combination with physiotherapy, where it synergistically improves the continence rate. For surgical treatment, the insertion of an artificial urinary sphincter, AS-800, is still the gold standard. In recent years, several minimal invasive treatment options have been introduced with different rates of success, but they have not yet surpassed the results of the artificial sphincter.