Surgical Options for Post-Prostatectomy Incontinence: A Review

Introduction: Post-prostatectomy incontinence affects anywhere from 1-40% of men after a radical prostatectomy, but treatment is often delayed and surgery is underperformed.1 Currently, the American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) recommends post-prostatectomy patients are offered conservative therapies including pelvic floor muscle training in the immediate post-operative period, and surgical treatment may be offered to those who have confirmed stress incontinence (SUI) and fail to respond to conservative therapies. Surgical treatment options are based on the degree of stress urinary incontinence. The artificial urinary sphincter is typically recommended for moderate to severe SUI, while the male sling can be considered in those with mild to moderate SUI.2 However, the AUS is considered a more reliable treatment, particularly for severe SUI after prostatectomy.

Methods: The study was conducted using the PubMed database for recent papers between 2001 and 2020 with variations of phrases such as post-prostatectomy incontinence, treatment, AUS, male sling [1]. articles were selected for review. The AUA/SUFU guidelines for incontinence after prostate treatment were also referenced.

Results: The AUS is considered the gold standard of post-prostatectomy incontinence therapy. However, male slings are gaining popularity in the treatment of mild to moderate PPI. The overall consensus is a need for prospective research based upon standardized patient workup and outcomes reporting to better compare the surgical options for PPI.

Conclusion: Standardized workup and outcomes reporting would benefit the patient in determining which surgical option best treats postprostatectomy incontinence. As of right now, there is no standardized approach apart from history and physical exam of the patient. Cystoscopy and urodynamics could be a beneficial tool in evaluation patients pre- and post-operatively. Prospective randomized control trials could then utilize a standardized approach to better compare the surgical options for PPI.

Keywords: Post-prostatectomy incontinence, AUS, Male sling

Abbreviations: AUA: American urological association; SUFU: Society of urodynamics, female pelvic medicine and urogenital reconstruction; PPI: Post-prostatectomy incontinence; AUS: Artificial urethral sphincter; SUI: Stress urinary incontinence; ppd: Pads per day; RCT: Randomized control trial