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Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review
John Heesakkers1, Fawzy Farag2, Ricarda M Bauer3
1Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
European Urology
|October 11, 2016
Summary
Postprostatectomy incontinence (PPI) is often caused by surgical factors like nerve damage and urethral length, alongside patient factors such as age and BMI. Understanding these causes can help improve continence after radical prostatectomy.
Area of Science:
- Urology
- Surgical Oncology
- Pelvic Health
Background:
- Postprostatectomy incontinence (PPI) is a growing concern, linked to increased rates of prostate cancer surgery.
- Pathophysiology of PPI is complex, involving multiple contributing factors.
Purpose of the Study:
- To review and analyze the various pathophysiologic mechanisms contributing to postprostatectomy incontinence.
- To synthesize current evidence on factors influencing continence after radical prostatectomy.
Main Methods:
- A comprehensive literature search was conducted on PubMed and EMBASE.
- 128 relevant publications were selected for final analysis after excluding non-pertinent studies.
Main Results:
- Key factors influencing PPI include neuromuscular elements, pelvic support, and surgical techniques.
- Preoperative patient characteristics (age, BMI, LUTS) and surgical factors (urethral length, nerve damage, fibrosis) significantly impact continence.
- Techniques like bladder neck sparing and anterior fixation show promise for improved outcomes.
Conclusions:
- Anatomical support and pelvic innervation are crucial for continence post-prostatectomy.
- Patient-specific and surgical factors significantly affect PPI, with ongoing research into reconstructive techniques.
