Impact of Parkinson's disease on continence after radical prostatectomy

It is widely believed that men with idiopathic Parkinson's disease (PD) should not undergo prostate surgery because of the prohibitively high risk of incontinence. However, the data supporting this conclusion were based on cohorts undergoing prostate surgery for voiding dysfunction, not for cancer control. Because both prostate cancer and PD are predominantly diseases of the elderly, it is likely that some men are concurrently diagnosed with both disorders who would otherwise be good candidates for radical prostatectomy (RP). However, the urinary outcomes in men with PD undergoing RP are unknown. Thus, it is possible that men with PD have been denied a potentially curative surgery only on the basis of long-standing assumptions. We addressed this issue by examining a cohort of men with PD who underwent RP at our institution.

We retrospectively reviewed a cohort of men who had undergone RP at our institution from 1990 to 2000. These men were surveyed 1 year after their surgery to determine their continence status, and their records were reviewed to determine whether any men had been preoperatively diagnosed with PD.

Of the 8415 men undergoing RP during the study period, 20 had PD and were included in our study. Their de novo incontinence rate at 1 year was 24%, with no patient requiring more than one to two pads per day.

Most men with PD undergoing RP remained continent 1 year after surgery. Additional studies with longer follow-up are required to determine whether this remains true over time.