A report of a regional service for post-prostatectomy urinary incontinence: a model for best practice?

Abstract

Introduction: Post-prostatectomy incontinence (PPI) is a potentially highly significant complication of a common urological procedure. Pathophysiology may be multifactorial but most commonly involves urinary sphincter weakness. The gold standard treatment for severe incontinence is artificial urinary sphincter but multiple alternatives exist. The growing incidence of PPI has led to the development of a specialized regional service dedicated to management Patients and methods: In 2004 a regional referral protocol for PPI was established with a dedicated clinic at a single centre for assessment and management including videourodynamics, pelvic floor rehabilitation, biofeedback and a consultant with a specialist interest in PPI surgery. Data regarding all in-house and tertiary referrals to this clinic between 2004 and 2011 were analysed with patients categorized by symptom severity. Results: A total of 267 patients were referred to the post-prostatectomy service (mean age 66.6, range 49-83 years) with numbers increasing year on year. Two-thirds of these were tertiary referrals: 27.7% of referrals were for mild symptoms, 35.2% moderate and 33.3% severe. One-third of referrals were made within 2 years of the primary procedure. Just over half of referred patients underwent invasive treatment including 24.3 artificial sphincter (24.3%) and male slings (22.8%). 7.5% patients were managed with medication, 14.6% were managed conservatively with containment therapy only. One-fifth remain under assessment or have deferred treatment. Conclusion: PPI is of increasing personal and societal impact which should be identified early and supported. Investigation and management can be standardized and intervention at a high volume centre achieved by early specialist referral.

Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence

“…Postprostatectomy urinary incontinence still remains a significant problem in 2015. Of patients suffering from postprostatectomy urinary incontinence (PPI) roughly two-thirds have mild to moderate and one-third have severe urinary incontinence [ 1 ]. Worldwide about 200 million people suffer from urinary incontinence of all causes [ 2 ].…”