Risk Factors for Urinary Incontinence after Radical Prostatectomy

Eastham, James A.; Kattan, Michael W.; Rogers, Eamonn; Goad, Jeremy; Ohori, Makoto; Boone, Timothy B.; Scardino, Peter T.

doi:10.1016/s0022-5347(01)65488-0

Cited by 462 publications

(211 citation statements)

References 28 publications

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“…2,8 Cambio and colleagues 5 reported an exhaustive analysis of the literature identifying the risk factors for urinary incontinence after RP. They analyzed the influence of perioperative factors (body weight, prostate volume, patient age, and pelvic floor exercise), anatomic factors (puboperinealis muscle-sparing dissection, trigonal denervation, and preservation of endopelvic fascia), and technical factors (bladder neck preservation, urethral length preservation, mucosal eversion, neurovascular bundle, and puboprostatic ligament preservation).…”

Section: Discussionmentioning

confidence: 99%

“…The reported percentages of patients with urinary incontinence after RP range from 6% to 20%. [1][2][3] However, improvements in surgical techniques and advances in the knowledge of pelvic and perineal anatomy have led to better preservation of continence and potency after RP. 4 Several factors have been proposed to affect male continence recovery after RP often with conflicting evidence.…”

Section: Introductionmentioning

confidence: 99%

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The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

Cho¹,

Lee²,

Kim³

et al. 2015

CUAJ

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Introduction: We investigate the influence of stretched membranous urethral length (SUL) and urethral circumference (UC) on postoperative recovery of continence after radical prostatectomy (RP). Methods: To evaluate the distal continence zone intraoperatively, we individually measured and recorded stretched membranous urethral length (distance between the urogenital diaphragm and the prostate apex with cephalad retraction, SUL) and urethral circumference (UC) after exposure of the urethra. We analyzed the association between magnetic resonance imaging-measured membranous urethral length (MRIL) and urethral diameter (MRID) and intraoperative SUL and UC and influence on return to continence. Results: The mean patient age, SUL and UC were 66.5 ± 6.0 years, 24.2 ± 3.3 mm, and 27.5 ± 4.4 mm, respectively. MRIL and MRID were 11.3 ± 1.6 mm and 10.6 ± 1.9mm, respectively. In the bivariate correlation analysis, there was no statistically significant correlation between SUL and MRIL (p = 0.201) and between UC and MRID (p = 0.124). In the Kaplan-Meier curve analysis, cumulative continence rates between the two groups dichotomized at the median value according to age (p = 0.0519), SUL (p = 0.6583), UC (p = 0.4031), MRIL (p = 0.4042), and MRID (p = 0.8191) were not significantly different. High SUL-to-MRIL ratio (>2.2) was the only significant predictor of lower cumulative continence rate (p = 0.0457). Conclusions: MRIL measured during surgery was not associated with postoperative continence recovery after RP. We observed that an excessively long membranous urethra compared to the urethral length on preoperative MRI is predictive of poorer postoperative continence recovery. However, small sample size and potential confounding surgical factors limit the significance of this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

Cho¹,

Lee²,

Kim³

et al. 2015

CUAJ

View full text Add to dashboard Cite

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“…11,12 The etiologies of SUI after prostatectomy include injury to the nerve, muscle fibers or support structures of the external urethral sphincter (EUS). [13][14][15] The somatic and autonomic neural innervation of the EUS arise from Onuf's nucleus of the sacral cord. [16][17][18] The postsynaptic autonomic neurons of the EUS have a high density of serotonergic and noradrenergic terminals.…”

Section: Discussionmentioning

confidence: 99%

Duloxetine for the treatment of post-prostatectomy stress urinary incontinence

Neff

Guise

Guralnick

et al. 2013

CUAJ

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E260 research researchCite as: Can Urol Assoc J 2013;7(5-6):e260-2. http://dx.doi.org/10.5489/cuaj.318 Published online May 13, 2013. AbstractObjectives: Stress urinary incontinence (SUI) is a known complication following prostatectomy. Duloxetine, a combined serotonin/ norepinephrine reuptake inhibitor, can decrease SUI by increasing urethral sphincter contractility. We examined the outcomes of patients with mild to moderate post-prostatectomy SUI treated with duloxetine. Methods: We conducted a retrospective review of men treated with duloxetine to manage mild to moderate post-prostatectomy SUI from 2006 to 2012. All patients received oral duloxetine 30 mg once a week, then 60 mg thereafter. Patients were seen one month later to determine drug efficacy and side effects. Results: In total, 94 men were included in the study. Daily pad usage decreased from 2.9 (range: 1-5) to 1.6 (range: 0-4) (p < 0.05). Incontinence Impact Questionnaire (IIQ-7) scores decreased from 13.0 (range: 6-18) to 7.9 (range: 2-16) (p < 0.05). Linear satisfaction scores improved from 0.8 (range: 0-2) to 2.0 (range: 1-3) (p < 0.05). Following a 1-month duloxetine trial, 33/94 (35%) men reported satisfactory SUI improvement and requested to continue the medication. The drug was discontinued in 61/94 (65%) patients due to poor efficacy in 32/94 (34%), intolerable side effects in 14/94 (15%) or both in 15/94 (16%). Reported side effects included fatigue, light-headedness, insomnia, nausea and dry mouth. Conclusions: Duloxetine improved post-prostatectomy SUI in 47/94 (50%) men following a 1-month trial. However, only 33/94 (35%) patients were able to tolerate the drug. Duloxetine may be considered a treatment option for men with mild to moderate post-prostatectomy SUI.

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“…Patients affected by leakage of urine due to insecure VUA may experience a longer period of catheterisation, longer hospital stay and a decreased quality of life [3]. VUA leakage is also one of the most important risk factors for postoperative urinary incontinence [4]. In addition, anastomotic urinary leakage and bladder neck strictures may result in urinary retention, pelvic abscess and a delayed return of continence, complications which commonly necessitate secondary procedures [3,5,6].…”

Section: Introductionmentioning

confidence: 99%

Single Running Suture versus Single-Knot Running Suture for Vesicourethral Anastomosis in Laparoscopic Radical Prostatectomy: A Prospective Randomised Comparative Study

et al. 2015

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Aim: To investigate the safety, surgical efficiency and patients' ability to recover from urinary continence as a result of a single absorbable running suture versus single-knot running suture for vesicourethral anastomosis (VUA) during laparoscopic radical prostatectomy (LRP). Material and Methods: In a prospective randomised study, we evaluated 162 consecutive patients who underwent LRP with VUA using the single running suture technique or the single-knot running suture technique. Perioperative patients' characteristics, morbidity and urinary continence were analysed. Results: The baseline characteristics were similar between the 2 groups. The single running suture technique was related to decreased anastomotic and total operative times compared with the Van Velthoven technique (13.17 ± 5.74 min vs. 28.49 ± 6.45 min, p = 0.0001, and 174.41 ± 62.97 min and 184.94 ± 46.16 min, p = 0.04, respectively). Overall, urinary continence rates at 3, 6 and 12 months in groups 1 and 2 were 49.4 and 69.1%, 81.5 and 86.4%, and 91.4 and 93.8%, respectively (all with p > 0.05 except the follow-up assessment at 3 months following surgery, p = 0.011). Conclusions: Both methods ensure satisfactory rates of urinary leakage and bladder neck stricture, as well as continence after LRP. However, since the single running suture VUA technique is easier to perform, and the mean anastomosis time of the single running suture VUA technique is shorter than that of the Van Velthoven technique, it appears, therefore, preferable.

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Risk Factors for Urinary Incontinence after Radical Prostatectomy

Abstract: While the risk of urinary incontinence after radical prostatectomy is related to the uncontrollable factor of patient age, it is also sensitive to the surgical technique used.

Cited by 462 publications

References 28 publications

The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

Duloxetine for the treatment of post-prostatectomy stress urinary incontinence

Single Running Suture versus Single-Knot Running Suture for Vesicourethral Anastomosis in Laparoscopic Radical Prostatectomy: A Prospective Randomised Comparative Study

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