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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Postprostatectomy incontinence: all about diagnosis and management.

Ricarda M Bauer¹, Patrick J Bastian, Christian Gozzi

¹Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany. Ricarda.Bauer@med.uni-muenchen.de

European Urology

|October 31, 2008

Summary

Postprostatectomy stress incontinence affects many men after radical prostatectomy. Current guidelines recommend a two-stage diagnostic approach and a range of treatments from pelvic floor training to artificial urinary sphincters.

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Area of Science:

Urology
Continence Management

Background:

Radical prostatectomy for prostate cancer leads to a rising incidence of postprostatectomy stress incontinence.
Despite surgical advancements, managing this condition remains a significant clinical challenge.

Purpose of the Study:

To review current diagnostic standards for postprostatectomy incontinence.
To assess contemporary management strategies, including noninvasive and surgical interventions.

Main Methods:

Comprehensive literature search of the PubMed database.
Inclusion of articles published from 2000 onwards for a contemporary review.

Main Results:

Recommended diagnostic tools include a two-stage assessment as per European Association of Urology (EAU) guidelines.
Noninvasive therapies (pelvic floor muscle training, biofeedback) are advised for early and mild cases.
Pharmacological treatment with duloxetine, especially combined with physiotherapy, shows synergistic benefits.
The artificial urinary sphincter (AS-800) remains the gold standard for surgical management.
Minimally invasive options show varied success but have not yet outperformed the artificial sphincter.

Conclusions:

A structured, two-stage diagnostic process is recommended for postprostatectomy incontinence.
A stepwise treatment approach, starting with conservative measures and progressing to surgical options if necessary, is advocated.
The artificial urinary sphincter (AS-800) represents the most effective surgical solution currently available.