Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence—a review

Abstract

Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.

Einsatz von Implantaten zur Versorgung der männlichen Harninkontinenz

“…Urodynamische Studien identifizieren assoziierte und prädisponierende Faktoren der Inkontinenz und ermöglichen es, die Ergebnisse von Implantationsoperationen vorherzusagen sowie das Versagen früherer Behandlungen zu verstehen. Bei Patienten nach radikaler Prostatektomie können Detrusorhyperaktivität oder -hypoaktivität und geringe Compliance festgestellt werden [42]. Obwohl die Ergebnisse der urodynamischen Studien im Allgemeinen keine Kontraindikationen für den Einsatz von Implantaten sind, liefern sie weitere Informationen hinsichtlich des Operationsergebnisses.…”

Experiences of Patients Who Developed Urinary Incontinence After Radical Prostatectomy: Focus Group Study

“…(1)(2)(3)(4) Radical prostatectomy is a common treatment of localized prostate cancer. (1,(4)(5)(6)(7) Urinary incontinence after radical prostatectomy is a complication that significantly affect the quality of life of the patients. (1,6,8,9) Urinary incontinence is defined as involuntary loss of urine by the International Continence Society.…”

“…(10,11) Currently, the prevalence of post-prostatectomy incontinence varies from 1% to 87%. (5) Urinary incontinence after prostatectomy adversely affects patients physically, psychologically and socially. (12,13) Urinary incontinence leads to the development of pressure ulcer, dermatitis, urinary tract infections, falls and fractures.…”