Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Post-prostatectomy Incontinence: Introduction and Prevalence

  • Chapter
  • First Online:
Post-Prostatectomy Incontinence

  • 598 Accesses

Abstract

Urinary incontinence after prostatectomy is a significant issue that can affect the quality of life in men who are undergoing treatment for prostate cancer. With the growing number of radical prostatectomies performed globally, the incidence of post-prostatectomy incontinence (PPI) continues to be on the rise. Several risk factors have been identified to predispose patients to PPI and increase the likelihood of postoperative incontinence. Early recognition of patients suffering from PPI is paramount to their timely management. Evaluation of these patients relies heavily on a thorough history and physical examination. Both conservative and surgical (sling or artificial urinary sphincter) approaches have been employed in treating PPI, though we presently lack a standardized clinical algorithm to appropriately stratify patients to the ideal treatment. In this chapter, we provide an introductory overview to PPI, with emphasis on its prevalence, impact, risk factors, pathophysiology, evaluation, and management. More in-depth discussions of underlying pathophysiology, approach to patient evaluation, and management options will be covered extensively elsewhere in this textbook.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.

    Article  PubMed  Google Scholar 

  2. Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, et al. The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. J Urol. 2004;171(4):1393–401.

    Article  PubMed  Google Scholar 

  3. Boorjian SA, Eastham JA, Graefen M, Guillonneau B, Karnes RJ, Moul JW, et al. A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes. Eur Urol. 2012;61(4):664–75.

    Article  PubMed  Google Scholar 

  4. Crivellaro S, Morlacco A, Bodo G, Agro EF, Gozzi C, Pistolesi D, et al. Systematic review of surgical treatment of post radical prostatectomy stress urinary incontinence. Neurourol Urodynam. 2015;35:875–81.

    Article  Google Scholar 

  5. Tewari AK, Ali A, Metgud S, Theckumparampil N, Srivastava A, Khani F, et al. Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing. World J Urol. 2013;31(3):471–80.

    Article  PubMed  Google Scholar 

  6. Hu JC, Elkin EP, Pasta DJ, Lubeck DP, Kattan MW, Carroll PR, et al. Predicting quality of life after radical prostatectomy: results from CaPSURE. J Urol. 2004;171(2 Pt 1):703–7. discussion 7-8

    Article  PubMed  Google Scholar 

  7. Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ, et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002;347(11):790–6.

    Article  PubMed  Google Scholar 

  8. Penson DF, McLerran D, Feng Z, Li L, Albertsen PC, Gilliland FD, et al. 5-Year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol. 2008;179(5 Suppl):S40–4.

    Article  PubMed  Google Scholar 

  9. Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou CC. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology. 2003;62(2):292–7.

    Article  PubMed  Google Scholar 

  10. Begg CB, Riedel ER, Bach PB, Kattan MW, Schrag D, Warren JL, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346(15):1138–44.

    Article  PubMed  Google Scholar 

  11. Jacobsen NE, Moore KN, Estey E, Voaklander D. Open versus laparoscopic radical prostatectomy: a prospective comparison of postoperative urinary incontinence rates. J Urol. 2007;177(2):615–9.

    Article  PubMed  Google Scholar 

  12. Sacco E, Prayer-Galetti T, Pinto F, Fracalanza S, Betto G, Pagano F, et al. Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. BJU Int. 2006;97(6):1234–41.

    Article  PubMed  Google Scholar 

  13. Singla AK. Male incontinence: pathophysiology and management. Ind J Urol. 2007;23(2):174–9.

    Article  Google Scholar 

  14. Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. JAMA. 2000;283(3):354–60.

    Article  CAS  PubMed  Google Scholar 

  15. Morey AF, Singla N, Chung P, Klein A, Tausch TJ, Siegel JA, et al. V3-03 male stress incontinence grading scale for evaluation of men with post-prostatectomy incontinence: a pilot study. J Urol. 2016;195(4 Suppl):e467.

    Article  Google Scholar 

  16. Haab F, Yamaguchi R, Leach GE. Postprostatectomy incontinence. Urol Clin North Am. 1996;23(3):447–57.

    Article  CAS  PubMed  Google Scholar 

  17. Sandhu JS. Treatment options for male stress urinary incontinence. Nat Rev Urol. 2010;7(4):222–8.

    Article  PubMed  Google Scholar 

  18. Majoros A, Bach D, Keszthelyi A, Hamvas A, Romics I. Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study). Neurourol Urodyn. 2006;25(1):2–7.

    Article  PubMed  Google Scholar 

  19. Wei JT, Dunn RL, Marcovich R, Montie JE, Sanda MG. Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol. 2000;164(3 Pt 1):744–8.

    Article  CAS  PubMed  Google Scholar 

  20. Pfister C, Cappele O, Dunet F, Bugel H, Grise P. Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinence. Neurourol Urodyn. 2002;21(3):194–7.

    Article  PubMed  Google Scholar 

  21. Cambio AJ, Evans CP. Minimising postoperative incontinence following radical prostatectomy: considerations and evidence. Eur Urol. 2006;50(5):903–13. discussion 13

    Article  PubMed  Google Scholar 

  22. Hammerer P, Huland H. Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy. J Urol. 1997;157(1):233–6.

    Article  CAS  PubMed  Google Scholar 

  23. Van Kampen M, De Weerdt W, Van Poppel H, Feys H, Castell Campesino A, Stragier J, et al. Prediction of urinary continence following radical prostatectomy. Urol Int. 1998;60(2):80–4.

    Article  PubMed  Google Scholar 

  24. Khan Z, Mieza M, Starer P, Singh VK. Post-prostatectomy incontinence. A urodynamic and fluoroscopic point of view. Urology. 1991;38(5):483–8.

    Article  CAS  PubMed  Google Scholar 

  25. Konety BR, Sadetsky N, Carroll PR, Ca PI. Recovery of urinary continence following radical prostatectomy: the impact of prostate volume--analysis of data from the CaPSURE database. J Urol. 2007;177(4):1423–5. discussion 5-6

    Article  PubMed  Google Scholar 

  26. Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR, et al. Incidence of urethral stricture after primary treatment for prostate cancer: data from CaPSURE. J Urol. 2007;178(2):529–34. discussion 34

    Google Scholar 

  27. Litwin MS, Lubeck DP, Henning JM, Carroll PR. Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol. 1998;159(6):1988–92.

    Article  CAS  PubMed  Google Scholar 

  28. Ficazzola MA, Nitti VW. The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol. 1998;160(4):1317–20.

    Article  CAS  PubMed  Google Scholar 

  29. Groutz A, Blaivas JG, Chaikin DC, Weiss JP, Verhaaren M. The pathophysiology of post-radical prostatectomy incontinence: a clinical and video urodynamic study. J Urol. 2000;163(6):1767–70.

    Article  CAS  PubMed  Google Scholar 

  30. Giannantoni A, Mearini E, Di Stasi SM, Mearini L, Bini V, Pizzirusso G, et al. Assessment of bladder and urethral sphincter function before and after radical retropubic prostatectomy. J Urol. 2004;171(4):1563–6.

    Article  PubMed  Google Scholar 

  31. Giannantoni A, Mearini E, Zucchi A, Costantini E, Mearini L, Bini V, et al. Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study. Eur Urol. 2008;54(3):657–64.

    Article  PubMed  Google Scholar 

  32. Catalona WJ, Basler JW. Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J Urol. 1993;150(3):905–7.

    Article  CAS  PubMed  Google Scholar 

  33. Moore KN, Truong V, Estey E, Voaklander DC. Urinary incontinence after radical prostatectomy: can men at risk be identified preoperatively? J Wound Ostomy Continence Nurs. 2007;34(3):270–9. quiz 80-1

    Article  PubMed  Google Scholar 

  34. Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the standardisation Committee of the International Children’s continence society. J Urol. 2006;176(1):314–24.

    Article  PubMed  Google Scholar 

  35. Rogers CG, Su LM, Link RE, Sullivan W, Wagner A, Pavlovich CP. Age stratified functional outcomes after laparoscopic radical prostatectomy. J Urol. 2006;176(6 Pt 1):2448–52.

    Article  PubMed  Google Scholar 

  36. Walsh PC, Partin AW, Epstein JI. Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. J Urol. 1994;152(5 Pt 2):1831–6.

    Article  CAS  PubMed  Google Scholar 

  37. Young MD, Weizer AZ, Silverstein AD, Crisci A, Albala DM, Vieweg J, et al. Urinary continence and quality of life in the first year after radical perineal prostatectomy. J Urol. 2003;170(6 Pt 1):2374–8.

    Article  PubMed  Google Scholar 

  38. Mohamad BA, Marszalek M, Brossner C, Ponholzer A, Wehrberger C, Willinger M, et al. Radical prostatectomy in Austria: a nationwide analysis of 16,524 cases. Eur Urol. 2007;51(3):684–8. discussion 9

    Article  PubMed  Google Scholar 

  39. Strasser H, Frauscher F, Helweg G, Colleselli K, Reissigl A, Bartsch G. Transurethral ultrasound: evaluation of anatomy and function of the rhabdosphincter of the male urethra. J Urol. 1998;159(1):100–4. discussion 4-5

    Article  CAS  PubMed  Google Scholar 

  40. Anast JW, Sadetsky N, Pasta DJ, Bassett WW, Latini D, DuChane J, et al. The impact of obesity on health related quality of life before and after radical prostatectomy (data from CaPSURE). J Urol. 2005;173(4):1132–8.

    Article  PubMed  Google Scholar 

  41. van Roermund JG, van Basten JP, Kiemeney LA, Karthaus HF, Witjes JA. Impact of obesity on surgical outcomes following open radical prostatectomy. Urol Int. 2009;82(3):256–61.

    Article  PubMed  Google Scholar 

  42. Wolin KY, Luly J, Sutcliffe S, Andriole GL, Kibel AS. Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity. J Urol. 2010;183(2):629–33.

    Article  PubMed  Google Scholar 

  43. Stone NN, Stock RG. Long-term urinary, sexual, and rectal morbidity in patients treated with iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urology. 2007;69(2):338–42.

    Article  PubMed  Google Scholar 

  44. Heidenreich A, Ohlmann C, Ozgur E, Engelmann U. Functional and oncological outcome of salvage prostatectomy of locally recurrent prostate cancer following radiation therapy. Urol A. 2006;45(4):474–81.

    Article  CAS  Google Scholar 

  45. Paparel P, Soulie M, Mongiat-Artus P, Cornud F, Borgogno C. Membres du sous-comite prostate du C. [salvage radical prostatectomy after external radiotherapy for prostate cancer: indications, morbidity and results. Review from CCAFU prostate section]. Prog Urol. 2010;20(5):317–26.

    Article  CAS  PubMed  Google Scholar 

  46. Sanderson KM, Penson DF, Cai J, Groshen S, Stein JP, Lieskovsky G, et al. Salvage radical prostatectomy: quality of life outcomes and long-term oncological control of radiorecurrent prostate cancer. J Urol. 2006;176(5):2025–31. discussion 31-2

    Article  PubMed  Google Scholar 

  47. Seabra D, Faria E, Dauster B, Rodrigues G, Fava G. Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer. Int Braz J Urol. 2009;35(1):43–8.

    Article  PubMed  Google Scholar 

  48. Burkhard FC, Kessler TM, Fleischmann A, Thalmann GN, Schumacher M, Studer UE. Nerve sparing open radical retropubic prostatectomy--does it have an impact on urinary continence? J Urol. 2006;176(1):189–95.

    Article  PubMed  Google Scholar 

  49. Nandipati KC, Raina R, Agarwal A, Zippe CD. Nerve-sparing surgery significantly affects long-term continence after radical prostatectomy. Urology. 2007;70(6):1127–30.

    Article  PubMed  Google Scholar 

  50. Zincke H, Oesterling JE, Blute ML, Bergstralh EJ, Myers RP, Barrett DM. Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol. 1994;152(5 Pt 2):1850–7.

    Article  CAS  PubMed  Google Scholar 

  51. Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156(5):1707–13.

    Article  CAS  PubMed  Google Scholar 

  52. Lepor H, Kaci L. The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments. J Urol. 2004;171(3):1216–9.

    Article  PubMed  Google Scholar 

  53. Lowe BA. Comparison of bladder neck preservation to bladder neck resection in maintaining postrostatectomy urinary continence. Urology. 1996;48(6):889–93.

    Article  CAS  PubMed  Google Scholar 

  54. Poon M, Ruckle H, Bamshad BR, Tsai C, Webster R, Lui P. Radical retropubic prostatectomy: bladder neck preservation versus reconstruction. J Urol. 2000;163(1):194–8.

    Article  CAS  PubMed  Google Scholar 

  55. Srougi M, Nesrallah LJ, Kauffmann JR, Nesrallah A, Leite KR. Urinary continence and pathological outcome after bladder neck preservation during radical retropubic prostatectomy: a randomized prospective trial. J Urol. 2001;165(3):815–8.

    Article  CAS  PubMed  Google Scholar 

  56. Kielb SJ, Clemens JQ. Comprehensive urodynamics evaluation of 146 men with incontinence after radical prostatectomy. Urology. 2005;66(2):392–6.

    Article  PubMed  Google Scholar 

  57. Harris MJ. Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management. Eur Urol. 2003;44(3):303–8. discussion 8

    Article  PubMed  Google Scholar 

  58. Weldon VE, Tavel FR, Neuwirth H. Continence, potency and morbidity after radical perineal prostatectomy. J Urol. 1997;158(4):1470–5.

    Article  CAS  PubMed  Google Scholar 

  59. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology. 2004;63(5):819–22.

    Article  PubMed  Google Scholar 

  60. Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T. Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol. 2003;169(5):1689–93.

    Article  PubMed  Google Scholar 

  61. Salomon L, Sebe P, De La Taille A, Vordos D, Hoznek A, Yiou R, et al. Open versus laparoscopic radical prostatectomy: part II. BJU Int. 2004;94(2):244–50.

    Article  PubMed  Google Scholar 

  62. Schick E, Jolivet-Tremblay M, Dupont C, Bertrand PE, Tessier J. Frequency-volume chart: the minimum number of days required to obtain reliable results. Neurourol Urodyn. 2003;22(2):92–6.

    Article  PubMed  Google Scholar 

  63. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA prostate cancer index: development, reliability, and validity of a health-related quality of life measure. Med Care. 1998;36(7):1002–12.

    Article  CAS  PubMed  Google Scholar 

  64. Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.

    Article  PubMed  Google Scholar 

  65. Smither AR, Guralnick ML, Davis NB, See WA. Quantifying the natural history of post-radical prostatectomy incontinence using objective pad test data. BMC Urol. 2007;7:2.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Starer P, Libow LS. The measurement of residual urine in the evaluation of incontinent nursing home residents. Arch Gerontol Geriatr. 1988;7(1):75–81.

    Article  CAS  PubMed  Google Scholar 

  67. Kowalczyk JJ, Spicer DL, Mulcahy JJ. Long-term experience with the double-cuff AMS 800 artificial urinary sphincter. Urology. 1996;47(6):895–7.

    Article  CAS  PubMed  Google Scholar 

  68. Nitti VW, Mourtzinos A, Brucker BM. Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU pad test study. J Urol. 2014;192(3):836–42.

    Article  PubMed  Google Scholar 

  69. Singla N, Singla AK. Post-prostatectomy incontinence: etiology, evaluation, and management. Turk J Urol. 2014;40(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Ozawa H, Chancellor MB, Ding YY, Nasu Y, Yokoyama T, Kumon H. Noninvasive urodynamic evaluation of bladder outlet obstruction using Doppler ultrasonography. Urology. 2000;56(3):408–12.

    Article  CAS  PubMed  Google Scholar 

  71. McGuire EJ, Fitzpatrick CC, Wan J, Bloom D, Sanvordenker J, Ritchey M, et al. Clinical assessment of urethral sphincter function. J Urol. 1993;150(5 Pt 1):1452–4.

    Article  CAS  PubMed  Google Scholar 

  72. Thiel DD, Young PR, Broderick GA, Heckman MG, Wehle MJ, Igel TC, et al. Do clinical or urodynamic parameters predict artificial urinary sphincter outcome in post-radical prostatectomy incontinence? Urology. 2007;69(2):315–9.

    Article  PubMed  Google Scholar 

  73. Twiss C, Fleischmann N, Nitti VW. Correlation of abdominal leak point pressure with objective incontinence severity in men with post-radical prostatectomy stress incontinence. Neurourol Urodyn. 2005;24(3):207–10.

    Article  PubMed  Google Scholar 

  74. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Marzocco M, Tosto A, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48(5):734–8.

    Article  PubMed  Google Scholar 

  75. Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet. 2000;355(9198):98–102.

    Article  PubMed  Google Scholar 

  76. Goode PS, Burgio KL, Johnson 2nd TM, Clay OJ, Roth DL, Markland AD, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA. 2011;305(2):151–9.

    Article  CAS  PubMed  Google Scholar 

  77. Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK, et al. EAU guidelines on surgical treatment of urinary incontinence. Actas Urol Esp. 2013;37(8):459–72.

    Article  CAS  PubMed  Google Scholar 

  78. Samli MSA, Aggarwal N. Artificial urinary sphincter vs. bone anchored male sling for post-radical prostatectomy urinary incontinence. Eur Urol suppl. 2005;4:143.

    Article  Google Scholar 

  79. Kumar A, Litt ER, Ballert KN, Nitti VW. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence--what do patients choose? J Urol. 2009;181(3):1231–5.

    Article  PubMed  Google Scholar 

  80. Satyanarayan A, Mooney R, Singla N. Surgical management of post-prostatectomy incontinence. EMJ Urol. 2016;4(1):75–80.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Nirmish Singla & Allen F. Morey

Authors
  1. Nirmish Singla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allen F. Morey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allen F. Morey .

Editor information

Editors and Affiliations

  1. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Ajay Singla

  2. Department of Urology, Stanford University School of Medicine, Stanford, California, USA

    Craig Comiter

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Singla, N., Morey, A.F. (2017). Post-prostatectomy Incontinence: Introduction and Prevalence. In: Singla, A., Comiter, C. (eds) Post-Prostatectomy Incontinence. Springer, Cham. https://doi.org/10.1007/978-3-319-55829-5_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55829-5_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55827-1

  • Online ISBN: 978-3-319-55829-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation