A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
Journal of clinical medicine. 2023 Feb 02*** epublish ***
Mauro Gacci, Cosimo De Nunzio, Vasileios Sakalis, Malte Rieken, Jean-Nicolas Cornu, Stavros Gravas
Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy., Department of Urology, Sapienza University, Ospedale Sant'Andrea, 00185 Rome, Italy., 'Agios Pavlos' General Hospital of Thessaloniki, 55134 Thessaloniki, Greece., Alta Uro AG, 4051 Basel, Switzerland., Urology Department, CHU de Rouen, F-76000 Rouen, France., Medical School, University of Cyprus, Nicosia 2029, Cyprus.