Conservative management of post-radical prostatectomy incontinence

Radical prostatectomy is currently the mainstay of treatment for localized prostate cancer. Although there is evidence that the evolution in surgical technique with the introduction of laparoscopic and robot-assisted radical prostatectomy has resulted in an improvement of functional outcomes, a significant percentage of patients are still bothered by post-prostatectomy incontinence. However, the majority of patients will find improvement in their continence status from conservative measures and a small cohort will require more invasive therapeutic options. Conservative treatment includes pelvic floor muscle training with or without biofeedback techniques and pharmacotherapy. There is evidence that immediate initiation of physiotherapy after surgery will help in early restoration of continence, while additional benefit can be provided from pharmacotherapy mainly from duloxetine. The present review aims to provide an update on the epidemiology of post-prostatectomy incontinence, identify risk factors for incontinence after surgery and suggest current trends for conservative treatment.