Management of Post Prostatectomy Urinary Incontinence

Abstract

Urinary incontinence is an involuntary loss of urine which can be very distressing to the patient and the relatives. The prostatic surgeries are among the common urologic procedures worldwide with it attendant consequences one of which is urinary incontinence and the commonest types of urinary incontinence after prostatectomy is stress urinary incontinence. With the advent of increase in dexterity because of use of modern surgical armamentarium ranging from finer and more précised instruments to minimally invasive procedures to robotic prostatectomy the risk of urinary incontinence is decline, Urinary incontinence is commonly seen in patients with early prostate cancer who have open radical prostatectomy usually due to increased risk of damaging the external sphincter, the stress incontinence seen in post radical prostatectomy requiring more than one pad per day is up to 5% of patients beyond six months, this is due to damage or injury to the external sphincter during division and control of dorsal vein complex bleeding but it can be as low as 0-1% post robotic radical prostatectomy, however in total incontinence the incidence is less than 3%. Sound knowledge of anatomy, adequate lightening and exposure with meticulous tissue handling goes a long way in reducing the chances of this distressing problem not only to the patient and his relatives but also to the surgeon. Although some studies have shown no much difference in terms of post prostatectomy urinary incontinence between open and laparoscopic radical prostatectomy in a high volume centre, however the use of robotic prostatectomy using the davinci system has a better outcome because one can operate through a few centimeters small incision with a magnified 3Dimentional high definition vision system with tiny wristed instruments that bend and rotate far greater than human wrist.