Current Urology Reports

, Volume 2, Issue 3, pp 248–252 | Cite as

Predicting continence following radical prostatectomy

  • David W. Marsh
  • Herbert Lepor
Article

Abstract

Stress urinary incontinence is a recognized complication following radical prostatectomy. Fortunately, in the hands of experienced surgeons, the overwhelming majority of men ultimately regain urinary continence following the procedure. Most men regain urinary continence 3 to 12 months after the prostatectomy. We have developed and validated a continence index that is administered at the time of catheter removal after radical prostatectomy. This index identifies those men who rapidly regain continence and men who will have permanent incontinence after prostatectomy. The study population was stratified into tertile groups based on the continence scores. At 3 months, 96%, 82%, and 68% of men in the highest, mid, and lowest tertile groups reported using no pads or one small pad. Based on these observations, we recommend initiating biofeedback immediately postoperatively in men with continence scores of 14 or less. At 1 year, 100%, 98%, and 87% of the men in the highest, mid, and lowest tertile group reported using no pads or only one small pad. Men who have continence scores greater than 14 can be assured that they will regain urinary continence within 1 year. To our knowledge, this index is the only validated instrument that predicts the return of urinary continence after radical prostatectomy.

Keywords

Radical Prostatectomy Stress Urinary Incontinence Stress Incontinence Localize Prostate Cancer Catheter Removal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References and Recommended Reading

  1. 1.
    Landis SH, Murray T, Bolden S, et al.: Cancer statistics, 1999. CA Cancer J Clin 1999, 49:8–31.PubMedGoogle Scholar
  2. 2.
    Haas GP, Sakr WA: Epidemiology of prostate cancer. CA Cancer J Clin 1997, 47:273–287.PubMedCrossRefGoogle Scholar
  3. 3.
    Fowler FJ, Barry MJ, Lu-Yao G, et al.: Effect of radical prostatec-tomy on patient quality of life: results from a Medicare survey. Urology 1995, 45:1007.PubMedCrossRefGoogle Scholar
  4. 4.
    Carlson KV, Nitti VW: Prevention and management of incontinence following radical prostatectomy. J Urol, In press.Google Scholar
  5. 5.
    Hadley HR, Zimmern PE, Eaz S: The treatment of male urinary incontinence. In Campbell's Urology edn 5. Edited by Patrick Walsh. Philadelphia: WB Saunders; 1986:2658.Google Scholar
  6. 6.
    Burnett AL, Mostwin JL: In situ anatomical study of the male urethral sphincteric complex: relevance to continence preservation following pelvic surgery. J Urol 1998, 160:1301.PubMedCrossRefGoogle Scholar
  7. 7.
    Myers RP: Male urethral sphincter anatomy and radical prostatectomy. Urol Clin North Am 1991, 18:211.PubMedGoogle Scholar
  8. 8.
    Gosling JA, Dixon JS, Critchley HOD: A comparative study of the human external sphincter and periurethral levator ani muscles. Br J Urol 1981, 53:25.CrossRefGoogle Scholar
  9. 9.
    Krahn HP, Morales PA: The effect of pudendal nerve anesthesia on urinary continence after prostatectomy. J Urol 1965, 94:282.PubMedGoogle Scholar
  10. 10.
    Hollobaugh RS, Duochowski RR, Kneib TG, et al.: Preservation of putative continence nerves during radical retropubic prostatectomy leads to rapid return of urinary continence. Urology 1998,Urology199851:960.CrossRefGoogle Scholar
  11. 11.
    Abrams P: Investigation of postprostatectomy problems. Urology 1980, 15:209.PubMedCrossRefGoogle Scholar
  12. 12.
    Abrams PH, Farrar DJ, Turner-Warwick RT, et al.: The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol 1979, 121:640.PubMedGoogle Scholar
  13. 13.
    Ficazzola MA, Nitti VW: The etiology of post-radical prostatec-tomy incontinence and correlation of symptoms with urodynamic findings. J Urol 1998, 160:13–17. This study demonstrates unequivocally that incontinence following radical prostatectomy is most typically due to stress incontinence.CrossRefGoogle Scholar
  14. 14.
    Steiner MS, Morton RA, Walsh PC: Impact of anatomical radical prostatectomy on urinary continence. J Urol 1991, 145:512.PubMedGoogle Scholar
  15. 15.
    Eastham JA, Kattan MW, Rogers E, et al.: Risk factors for urinary incontinence after radical prostatectomy. J Urol 1996, 156:1707–1713.PubMedCrossRefGoogle Scholar
  16. 16.
    Walsh PC, Partin AW, Epstein JI: Cancer control and quality of life following radical retropubic prostatectomy: results at 10 years. J Urol 1994, 152:1831.PubMedGoogle Scholar
  17. 17.
    Klein EA: Early continence after radical prostatectomy. J Urol 1992, 148:92.PubMedGoogle Scholar
  18. 18.
    Litwin MS, Hays RD, Fink A, et al.: Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 1995, 273:129.PubMedCrossRefGoogle Scholar
  19. 19.
    Litwin MS, Lubeck DP, Henning JM, Carroll PR: Differences in urologist and patient assessments of the health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol 1998, 159:1988–1992.PubMedCrossRefGoogle Scholar
  20. 20.
    Wei JT, Dunn RL, Marcovich R, et al.: Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol 2000, 164:744. This study represents one of the first prospective assessments of urinary continence following radical prostatectomy using validated outcome measurements.PubMedCrossRefGoogle Scholar
  21. 21.
    Jackson J, Emerson L, Johnston B, et al.: Biofeedback: a noninvasive treatment for incontinence after radical prostatectomy. Urol Nurs 1996, 16:50.PubMedGoogle Scholar
  22. 22.
    Cammu H, Van Nylen M: Pelvic floor muscle exercises: 5 years later. Urology 1995, 45:113.PubMedCrossRefGoogle Scholar
  23. 23.
    Franke JJ, Gilbert WB, Grier J, et al.: Early post-prostatectomy pelvic floor biofeedback. J Urol 2000, 163:191.PubMedCrossRefGoogle Scholar
  24. 24.
    Twiss C, Martin S, Shore R, Lepor H: A continence index predicts the early return of urinary continence after radical retropubic prostatectomy. J Urol 2000, 164:1241. This report presents a continence index administered at the time of catheter removal following radical prostatectomy which predicts the early return of urinary continence and final continence status.PubMedCrossRefGoogle Scholar
  25. 25.
    Walsh PC: Radical retropubic prostatectomy. In Campbell's Urology edn 6. Philadelphia: WB Saunders; 1992:2865–2886.Google Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • David W. Marsh
    • 1
  • Herbert Lepor
    • 1
  1. 1.Department of UrologyNew York University Medical CenterNew YorkUSA

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