Management of incontinence after radical prostatectomy: How good are we now?

Abstract

Prostate cancer is common. Radical prostatectomy is a common treatment option for patients with localized disease. Post-prostatectomy stress urinary incontinence (PPSUI) is not uncommon. It is the single strongest predictor of patient health-related quality of life following prostatectomy. Although the reported incidence varied widely due to the lack of standardized definition of PPSUI, management of PPSUI should fundamentally be part of prostate cancer survivorship rehabilitation program. An understanding of risk factors for PPSUI can potentially help risk-stratify patients for long-term voiding dysfunction. Despite it being a common issue amongst patients after surgery, optimal evaluation prior to consideration of treatment remains controversial. Artificial urinary sphincter (AUS) implantation is by far the most common surgery used to manage patients with significant PPSUI if conservative treatment failed. However, AUS is not without its associated pitfalls and risks. Male slings have gained popularity amongst patients recently, but it lacks long-term efficacy outcomes. This lecture aims to provide an update in the diagnosis, assessment, and management of men with PPSUI.