Prevention and treatment of incontinence after radical prostatectomy

Postoperative complications after radical prostatectomy have only recently been studied in a formal prospective manner. A survey of existing literature yields widely disparate rates of postoperative incontinence. Classically, about 5% of patients were believed to be incontinent. More recent studies that involve patient questionnaires and a specific continence history indicate that nearly 30% of patients experience some urinary leakage with activity. Evolving new operative techniques such as modified apical dissection and construction of a tubularized neourethra have potential to improve continence rates considerably. Patients who do experience urinary incontinence should be offered appropriate evaluation and treatment. In addition to cystourethroscopy, all patients should undergo cystometry and Valsalva leak-point testing to differentiate sphincteric dysfunction from detrusor instability. Injection of bovine cross-linked collagen into the preexternal sphincter zone or implantation of the artificial urinary sphincter are options for treatment of intrinsic sphincter dysfunction. Detrusor instability is best treated with pharmacotherapy. This article discusses the details of prevention, evaluation, and treatment of postprostatectomy incontinence.