How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Abstract

Aims: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). Methods: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" Results: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate.More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates.Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes.Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP.Conclusions: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.

Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy

“…To minimize surgery-related neuromuscular effects of radical prostatectomy, modifications to the surgical technique have included Retzius-sparing surgery, endopelvic fascia preservation, and the use of different sutures and stitches. However, these modifications to the surgical technique have not been universally accepted owing to the inability to identify, preoperatively, patients at high risk of urinary incontinence, concerns about overtreatment and a lack of empirical data demonstrating effectiveness of the modifications 93 – 95 .…”

“…For example, intrinsic sphincter dysfunction or overactive bladder symptoms can be identified and treatment interventions commenced in the prehabilitation period 52 , 196 , 197 . Studies report that patients with poor urinary incontinence and overactive bladder symptom scores before radical prostatectomy also had worsening of symptom scores at all time points after radical prostatectomy 95 , 198 – 200 .…”

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

“…Prostate cancer is the most frequent malignancy in males, accounting for 21% of newly diagnosed cancers in males worldwide [1]. Despite notable improvements regarding the aetiology of post-prostatectomy incontinence (PPI) and the surgical technique, this sequel to prostate cancer treatment is still disturbingly high [2].…”

Long‐term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study

“…K E Y W O R D S adjustable transobturator male system (ATOMS), durability, effectiveness, long-term results, male incontinence 1 | INTRODUCTION Persistent stress urinary incontinence (SUI) is a common complication after prostate cancer treatment. 1 Approximately, 3% to 6% of patients receiving radical prostatectomy in different health care systems worldwide undergo subsequently surgery for male SUI, with 25% of them requiring multiple surgeries. [2][3][4] The actual proportion of cases experiencing moderate-to-severe SUI is estimated at 10% to 20%.…”