Urinary incontinence after radical prostatectomy

Urinary incontinence after radical prostatectomy is common, but in most patients the symptoms are transitory and subside spontaneously within several days to several months. During the recovery period, suitable means of managing the incontinence must be devised. These include absorbent pads, penile clamps, condom catheters, and occasionally indwelling catheters. Even at this early stage, it is important to exclude two remediable conditions—urinary tract infection and urinary retention. For the 5‐10% of patients with persistent incontinence, the diagnosis and treatment is more difficult than a review of the literature might suggest and requires a complete evaluation, including micturition diaries and pad tests, urodynamics (including detrusor pressure/uroflow studies), and cystoscopy. The causes of postprostatectomy incontinence include sphincter malfunction, detrusor abnormalities, and urinary retention with overflow. Detrusor abnormalities include involuntary detrusor contractions, impaired or ibsent detrusor contractility, and low bladder compliance. Involuntary detrusor contractions may be caused by urinary tract infection, bladder outlet obstruction, bladder stones, carcinoma of the bladder, retained sutures or other foreign bodies, and neurologic conditions. Treatment of involuntary detrusor contractions includes (1) alleviating the underlying cause, (2) anticholinergics, (3) behavior modification, (4) biofeedback and (5) electrical stimulation. Most sphincteric incontinence is self‐limited. Persistent sphincteric incontinence is usually associated with anastomotic scarring. The only surgical treatment of proven efficacy is sphincter prosthesis, but this should be considered only after about 1 year has elapsed, unless the incontinence is particularly severe and is clearly not improving. Periurethral injections of substances such as collagen show promise, with almost inconsequential morbidity, but are still in an evolutionary mode. Cancer 1995;75:1978–82.