Post-Prostatectomy Urinary Incontinence: A Confluence of 3 Factors

Loughlin, Kevin R.; Prasad, Michaella M.

doi:10.1016/j.juro.2009.11.011

Cited by 94 publications

(58 citation statements)

References 47 publications

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“…Patient age is the one demographic factor most commonly linked to continence and time to continence; however, the predictive strength of age and all other baseline factors, such as body mass index, prostate weight, AUA symptom score, is weak at best. [12][13][14] Our study confirms these previous findings as presented in Table 1. In addition, we found preoperative uroflowmetry (VV, PVR, PFR) had no predictive findings.…”

Section: Discussionsupporting

confidence: 92%

Simple Method to Predict Return of Continence After Robot-Assisted Radical Prostatectomy

Skarecky

Morales

Chang

et al. 2011

Journal of Endourology

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Background and Purpose: After removal of the Foley catheter after robot-assisted radical prostatectomy (RARP), recovery of continence can take days to months. We sought to identify a simple means to predict time to recovery of postoperative continence. Patients and Methods: Preoperative characteristics on 172 men who were undergoing RARP were entered into an electronic database. All men were queried via telephone and/or returned a 7-day log of pad use. Men without need for pads were excluded (n = 41). At 4 to 7 days, responses were grouped as: one pad (n = 55), two pads (n = 35), or three or more pads (n = 41). Patients returned self-addressed postcards noting the date of 0-pad urinary status. Univariate and multivariate analysis of variables were assessed for ability to predict time to continence. Results: No preoperative factors, such as age, International Index of Erectile Function-5, prostate-specific antigen level, American Urological Association symptom score, body mass index, uroflowmetry, nervesparing status, estimated blood loss, or prostate weight, were found to predict time to continence. Pad use at 4 to 7 days, however, was highly correlated with median time to continence. The median time to continence for men using one pad was 35 days, two pads was 42 days, and for three or more pads was 73 days (P = 0.0001). Conclusions: As has been previously reported, we found no reliable baseline factors that predicted postoperative time to 0-pad continence. We did find that determining pad usage at 4 to 7 days after catheter removal strongly predicted time to pad-free continence. This method is simpler then pad weights, predicts high-and low-risk men for delayed continence, and can be used for counseling/intervention.

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Section: Discussionsupporting

confidence: 92%

Simple Method to Predict Return of Continence After Robot-Assisted Radical Prostatectomy

Skarecky

Morales

Chang

et al. 2011

Journal of Endourology

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“…37,38 It is well known that urinary incontinence is the most devastating complication after RP. 39 Its clear that continent patients are more interested in resuming sexual function than incontinent ones, who have been shown to have lower sexual function satisfaction. 35 They may be distressed by their condition as well as embarrassed to try to engage in sexual activities.…”

Section: 15--1729mentioning

confidence: 99%

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

et al. 2012

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Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n ¼ 26) receiving PFBT once a week for 3 months and home exercises or a control group (n ¼ 26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score 420. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P ¼ 0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8--64%) and the number needed to treat was 3 (95% CI: 1.5--17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P ¼ 0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent. 1 The most common long-term complications after prostatectomy (RP) are urinary incontinence and erectile dysfunction (ED).2 ED is estimated to affect 26--100% of patients after surgery. 3,4 The main cause of ED after RP is neurogenic, because of intraoperative injury to the neurovascular bundle.

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“…This range is wide due to variations in the definition of urinary incontinence, patient selection and surgical technique. A number of risk factors for urinary incontinence have been analyzed (3,4). These include preoperative factors (patient age, body weight and prostate volume) and intraoperative factors (operative method: open vs. laparoscopy, bladder-neck preservation, urethral length preservation, neurovascular bundle sparing and puboprostatic ligament sparing).…”

Section: Introductionmentioning

confidence: 99%

Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

et al. 2011

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Abstract. Urinary incontinence is a major complication following radical prostatectomy. The aim of the present study was to assess the association between urinary continence following laparoscopic radical prostatectomy (LRP) and various factors measured using real-time intraoperative transrectal ultrasonography (TRUS). Patients (n=53) with localized prostate cancer underwent LRP in combination with real-time intraoperative TRUS navigation and were evaluated for urinary continence for more than 6 months following LRP. Prostate size, membranous urethral length (MUL) and bladder-urethra angle were measured using real-time intraoperative TRUS immediately before and after surgery. Urinary continence was regained by 4, 15 and 27 patients 1, 3 and 6 months after LRP, respectively. Longer postoperative MUL was significantly correlated with recovery of urinary continence 1, 3 and 6 months after LRP. In addition, an increase in difference between preoperative and postoperative MUL was also associated with superior continence. No correlation was observed between postoperative MUL and the rate of tumor-positive surgical margins. Larger prostate volume was correlated to postoperative continence 6 months after surgery. Shorter operation time and less blood loss resulted in postoperative urinary continence 1 month after LRP. Preoperative MUL, bladder-urethra angle, age and body mass index had no correlation with urinary continence. Postoperative MUL was the most significant factor for early recovery of urinary continence following LRP. These results indicate that preservation of longer urethra during surgery may be recommended without tumor-positive surgical margins.

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Post-Prostatectomy Urinary Incontinence: A Confluence of 3 Factors

Cited by 94 publications

References 47 publications

Simple Method to Predict Return of Continence After Robot-Assisted Radical Prostatectomy

Simple Method to Predict Return of Continence After Robot-Assisted Radical Prostatectomy

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

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