Treatment of urinary incontinence after radical prostatectomy

Abstract

Introduction: Advances in the diagnosis and treatment of adenocarcinoma of the prostate have resulted in an increase in the prevalence of urinary incontinence following radical prostatectomy, resulting in a demand for techniques to manage this condition.

Material and Methods: A review was conducted of the literature with respect to the results of the principal forms of therapy, either conservative methods (pelvic floor physiotherapy, electrical stimulation and external devices) or non-conservative methods (pharmacological treatment, periurethral bulking agents, artificial urinary sphincter, slings and adjustable balloons).

Results: Pelvic floor physiotherapy only accelerates the recovery of continence. Results with electrical stimulation are poor and do not justify the expense. External devices are not very effective under comfortable pressures. Pharmacological treatment with duloxetine appears promising. Periurethral bulking agents require repeat injections. Success rates with artificial urinary sphincter reach as high as 90%. Efficacy rates with the sling range from 41.7% to 86% in patients with mild or moderate incontinence. Adjustable balloons have a success rate of 67%; however, frequent readjustment is required.

Conclusions: After one year, results with pelvic floor physiotherapy and electrical stimulation are no better than those achieved following simple instructions to perform pelvic floor muscle exercises. External devices should be used only in patients for whom surgery is contraindicated. Duloxetine should become the standard treatment for mild stress urinary incontinence. Periurethral bulking agents are only effective over the short term. Artificial urinary sphincter remains the gold standard for the treatment of incontinence; however, it is invasive, requires follow-up and is expensive. The sling is a good alternative for mild to moderate incontinence in patients who refuse to undergo further surgery, who are unable to operate the artificial urinary sphincter system or who have financial restraints. Adjustable balloons are useful in patients for whom surgery is contraindicated; however, readjustments are often necessary