urinary incontinence post prostatic surgery

Dr. Abdullah Ahmad Ghazi (R5)KSMC

19-12-1432

Estimated as:5-69% of women1-39% of men.

Age. LUTS. Infection. Functional and cognitive impairment. Neurological disorders. Prostatectomy.

Sphincter-relatedPostoperative

Post-prostatectomy for benign disease Post-prostatectomy for prostate cancer Post radiotherapy, brachytherapy, cryosurgery,

HIFU for prostate cancer Post cystectomy and neobladder for bladder

cancerPost-traumatic

After prostato-membranous disruption and urethral reconstruction

Pelvic floor traumaUnresolved paediatric UIExstrophy and incontinent epispadias

Bladder-relatedRefractory UUI (overactive bladder)Reduced capacity bladder

FistulaeUrethro-cutaneousRecto-urethral

Hx Ex Urine analysis PVR Voiding diary. Pad test. Renal profile. U.cystoscopy. Image (U/S, VCUG, IVP). UDS.

BPH Incidence of UI is similar after (TURP, TUIP,

Holium enucleation and open surgery). Pr Ca

Reported 5-48%.

Assessed by:Numbers of pads and their wetness.Social impairment.Bothersomeness.

Total control without any pad. Leakage:

No pad but loss of few drops of urine ‘underwear staining’.

None or 1 pad ‘safety pad’ per day.

Age at surgery. Prostate size. Co-morbidity. Nerve sparing surgery. Bladder neck stenosis. Tumour stage (possibly related to

surgical technique) Preoperative bladder and sphincter

dysfunction.

How long to wait ?

Artificial urinary sphincter (AUS) success rate 59-90%.

Male slings 58%.Bulking agents, early failure 50%.

Cognitive impairment.

Dexterity restriction.

?

Risk is 0-18.9%, increase with time.

More as adjuvant therapy, or Hx of TURP.

AUS post XRT associated with more complications.

Perineal compression slings (limited evidence).

Injectable agents (not successful).

Brachytherapy 0-45%. Cryotherapy 0-5%. HIFU

Rx: AUR Injectable material not successful.

Cause of incontinence after AUS:

Alteration in bladder function.Urethral atrophy.Mechanical malfunction.