Beyond Surgical Technique: Evolving Strategies to Reduce Urinary Incontinence After Radical Prostatectomy

Radical Prostatectomy is one of the standard treatments for localized clinically significant prostate cancer (PCa). However, despite advances in surgical technique such as the robotic radical prostatectomy (RARP), stress urinary incontinence (SUI) remains a common side effect. Patient counseling should include a discussion of preoperative predictors of incontinence including obesity, larger prostate size and shorter membranous urethral length. To improve surgical outcomes, several management strategies have been developed. These include surgical techniques such as the Rocco Stitch, the Hood-technique, and Retzius-sparing RARP. Novel treatments, devices and multimodal approaches are emerging including prehabilitation, remote and digital pelvic floor muscle training, novel neuromodulation, automated artificial urinary sphincters, and surgical augmentation of the vesicourethral anastomosis. These new strategies offer the potential for improved continence without compromising oncologic outcomes. Overall, incontinence prevention and treatment after RARP is becoming increasingly individualized with many options available for clinicians to offer to patients. Continued innovation and discovery in functional recovery after RP are imperative.