Post-Radical Prostatectomy Incontinence: Etiology and Prevention

All patients undergoing a radical prostatectomy (RP) using any surgical approach, be it open, laparoscopic, or robotic, are at risk of developing postprostatectomy urinary incontinence. This side effect of RP has an effect on the patient’s quality of life and can be associated with moderate to severe postoperative morbidity. The authors present a review of the etiology and prevention strategies of postprostatectomy urinary incontinence. Based on the current literature, the authors conclude that there is a paucity of studies that can accurately answer the exact anatomic and physiologic etiologies of postprostatectomy urinary incontinence. The aim of urologic surgeons performing RP should be to reduce the rate of postoperative incontinence rather than attempting to treat it once it has occurred. Further studies aimed at providing a detailed anatomic map of the pelvic anatomy related to continence will help to improve surgical techniques and reduce postoperative urinary incontinence following RP.Key words: Radical prostatectomy, Urinary incontinence, Urethral lengthProstate cancer is the most common cancer in men over age 50 years.¹ The most common treatment for organ-confined disease in a suitably selected patient is a radical prostatectomy (RP); however, one of the major morbidities of this procedure is urinary incontinence. Rates of postoperative incontinence range from 4% to 8%^1,2; however, rates may be much higher depending on definitions used and whether validated questionnaires of incontinence were used. Most studies quantify postprostatectomy urinary incontinence accurately as the number of pads being used as a marker of the degree of urinary incontinence.³ Examining the potential causes of postprostatectomy incontinence is important for prevention, but, at present, our understanding is limited, due in part to the lack of anatomic and functional knowledge of continence, as well as the lack of postoperative studies.