Post-Prostatectomy Urinary Incontinence: A Confluence of 3 Factors

Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
The Journal of urology (Impact Factor: 4.47). 03/2010; 183(3):871-7. DOI: 10.1016/j.juro.2009.11.011
Source: PubMed


Urinary incontinence has a significant impact on the quality of life of patients who undergo radical prostatectomy for prostate cancer. We reviewed available published data to analyze the etiology and prevention of this surgical complication.
A MEDLINE search of the literature on this topic was performed.
There was a wide disparity in the reported rates of urinary incontinence after radical prostatectomy due to various reasons including definitions, patient selection and intraoperative technical factors.
Postoperative urinary incontinence has a major impact on patient satisfaction after radical prostatectomy. Attention to factors including patient selection, nuances of the surgical technique, and a more uniform, widespread agreement on the definition and instruments to measure postoperative incontinence is needed to enhance surgical outcomes. In addition, further research is needed to improve the diagnosis and treatment of urinary incontinence after prostate cancer surgery.

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Available from: Michaella Maloney Prasad, Apr 09, 2015
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    • "Open retropubic radical prostatectomy is a commonly performed procedure for clinically localized prostate cancer [1] [2]. It is increasingly desirable for young age patients, as the demand for high level functional outcomes after therapy becomes more critical [3] [4]. "
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    ABSTRACT: Background. Open retropubic radical prostatectomy is a commonly performed procedure for clinically localized prostate cancer. The demand for high level functional outcomes after therapy is increasing especially for young age patients; in this regard refinements in the surgical technique have been made. There is limited data to show the success of some of these refinements in resource limited settings. Methods. A retrospective clinical study was performed over a 2-year period at Mengo Hospital, Urology Unit. Men with clinically localized prostate cancer and who consented to the procedure were eligible and were recruited. Consequently excluded were those that turned out to have advanced disease and those with severe comorbidities. Patients were followed up for 3 months after surgery. Data was entered using SPSS version 17 and analyzed. Results. A total of 24 men with clinically localized prostate cancer underwent open retropubic puboprostatic ligament preserving radical prostatectomy technique. Mean age was 66, range 54–75 years. Outcome. Two patients had stress incontinence and three were incontinent at 3 months. The urinary continence recovery rate was 19/24 (79%) at 3 months. Conclusion. Preservation of the puboprostatic ligament in open retropubic radical prostatectomy was associated with rapid and a high rate of return to urinary continence among men with clinically localized disease.
    Full-text · Article · Dec 2014 · International Scholarly Research Notices
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    • "Aging, comorbidities, obesity, benign prostatic hypertrophy, prostate cancer and its treatments may increase the risk of UI [3]. Urinary continence recovery following radical prostatectomy is variable with 5-30% of patients still requiring pads one year after surgery [4,5]. The incidence of UI after external beam radiation therapy or brachytherapy varies considerably with a reported range of 10% to 30% [6-9]. "
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    ABSTRACT: Purpose Urinary incontinence (UI) following prostate radiotherapy is a rare toxicity that adversely affects a patient’s quality of life. This study sought to evaluate the incidence of UI following stereotactic body radiation therapy (SBRT) for prostate cancer. Methods Between February, 2008 and October, 2010, 204 men with clinically localized prostate cancer were treated definitively with SBRT at Georgetown University Hospital. Patients were treated to 35–36.25 Gray (Gy) in 5 fractions delivered with the CyberKnife (Accuray). UI was assessed via the Expanded Prostate Index Composite (EPIC)-26. Results Baseline UI was common with 4.4%, 1.0% and 3.4% of patients reporting leaking > 1 time per day, frequent dribbling and pad usage, respectively. Three year post treatment, 5.7%, 6.4% and 10.8% of patients reported UI based on leaking > 1 time per day, frequent dribbling and pad usage, respectively. Average EPIC UI summary scores showed an acute transient decline at one month post-SBRT then a second a gradual decline over the next three years. The proportion of men feeling that their UI was a moderate to big problem increased from 1% at baseline to 6.4% at three years post-SBRT. Conclusions Prostate SBRT was well tolerated with UI rates comparable to conventionally fractionated radiotherapy and brachytherapy. More than 90% of men who were pad-free prior to treatment remained pad-free three years following treatment. Less than 10% of men felt post-treatment UI was a moderate to big problem at any time point following treatment. Longer term follow-up is needed to confirm late effects.
    Full-text · Article · Jun 2014 · Radiation Oncology
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    • "In future trials, the patients' continence status should be defined and evaluated using validated questionnaires and not by clinicians. Generally, uniform standards and instruments to measure postoperative incontinence are needed [23]. In order to receive a more comprehensive overview on the patients' continence status, further information is required , e.g., the patients' self-assessment and knowledge about the type of incontinence (urge and stress inconti- nence). "
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    ABSTRACT: OBJECTIVE:: The study examined and compared continence rates in prostate cancer patients who had undergone either open retropubic prostatectomy (RRPE) or endoscopic extraperitoneal radical prostatectomy (EERPE). The core question was whether the surgical approach had an effect on the patients' continence status 3 months after surgery. METHODS:: We conducted a multicentric, longitudinal study in 7 German hospitals. Three hundred fifty prostate cancer patients (166 EERPE, 184 RRPE) were asked to self-assess symptoms associated with urinary incontinence (UI) 1 day before and 3 months after prostatectomy. Symptoms of UI were assessed using the EORTC QLQ-PR25 questionnaire. Urinary continence was defined according to (1) the use of no protective pad, (2) the use of up to a single protective pad in a 24-hour period, and (3) according to the patient's self-assessment. A binary regression model was employed to predict early continence status. RESULTS:: Three months after prostatectomy, 44% of patients who underwent EERPE and 40% of patients who underwent RRPE were completely continent. Patients who underwent nerve-sparing prostatectomy and patients younger than 65 years had a better chance of regaining urinary continence earlier. The surgical approach had no significant impact on the patients' continence status. Limitations of the study are a drop-out rate of 39% and sociodemographic and clinical differences between both treatment groups. CONCLUSIONS:: Three months after prostatectomy, there were no significant differences between both treatment groups regarding urinary continence. The surgical approach had no significant effect on the patients' continence status. Higher age and non-nerve-sparing surgery are associated with a longer period of convalescence.
    Full-text · Article · Jun 2011 · Urologic Oncology
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