Abstract
Preservation of postoperative urinary continence remains the primary concern of all men and their surgeons following robot-assisted radical prostatectomy (RARP). Without doubt, continence is the most important quality of life issue following radical prostatectomy. Identification of difficulties and lessons learned over time has helped focus efforts in order to improve urinary quality of life and continence. This review will examine definitions of continence and urinary quality of life evaluation, technical aspects and the impact of patient-related factors affecting time to and overall continence.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Loughlin KR, Prasad PM. Post-prostatectomy incontinence: a confluence of 3 factors. J Urol. 2010;183(3):871–7. Very good overview of continence after radical prostatectomy.
•• Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405–17. Excellent Review of current robotic prostatectomy outcomes.
Walsh PC, Marchle P, Ricker D, et al. Patient reported urinary continence and sexual function after radical prostatectomy. Urol. 2000;55:58–62.
Wei JT, Montie JE. Comparison of patient’s and physician’s rating of urinary incontinence following radical prostatectomy. Semin Urol Oncol. 2000;18:76–80.
Kundu SD, Roehl KA, Eggener SE, et al. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172:2227–31.
Liss MA, Osann K, Canvasser N, et al. Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient reported validated questionnaires. J Urol. 2010;183(4):1464–8.
Chou M, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2011;155:762–71.
Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. 2005;65(4):740–4.
Link BA, Nelson R, Josephson DY, et al. The impact of prostate gland weight in robot assisted laparoscopic radical prostatectomy. J Urol. 2008;180(3):928–32.
Castle EP, Atug F, Woods M, et al. Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol. 2008;26(1):91–5.
Skarecky D, Morales B, Chang A, Ahlering T. Simple prediction method of return to pad-free continence for men undergoing Robotic Radical Prostatectomy (RARP). J Endourol. 2011;25(9):1451–5.
Twiss C, Martin S, Shore R, Lepor H. A continence index predicts the early return of urinary continence after radical retroubic prostatectomy. J Urol. 2000;164:1241–7.
Ates M, Teber D, Gozen AS, et al. A new postoperative predictor of time to urinary continence after laparosocpic radical prostatectomy: the urine loss ratio. Eur Urol. 2007;52:178–85.
Van Kampen M, De Weerdt GW, Van Poppel H. An easy prediction of urinary incontinence duration after retropubic radical prostatectomy based on urine loss the first day after catheter withdrawal. J Urology. 2009;181:2461–646.
Perimenis P, Burkhard FC, Kessler TM, et al. Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern. Eur Urol. 2004;46(5):406–9.
Ahlering T, Morales B, Van T, et al. Nocturnal versus daytime pad free continence following Robotic-Assisted Radical Prostatectomy. J Endourol. 2012;26(Supp1):132. MP 19–14.
Rodriguez E, Skarecky DW, Ahlering TE. ‘Perfect’ continence outcomes after laparoscopic radical prostatectomy. Urology. 2006;67(4):785–8.
Majoros A, Bach D, Kesztelyi A. Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study). Neurourol Urodyn. 2006;25:2.
Van Velthoven RF, Ahlering TE, Peltier A, et al. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003;61(4):699–702.
van Velthoven R, Rodriguez Jr E, Abbou CC, et al. Single Knot Anastomosis (SKA) for laparoscopic radical prostatectomy: an International Multicenter Outcome Survey of 5,235 cases. J Endourol. 2007;21(Supp1):MP08–9. A64.
Rocco F, Carmignani L, Acquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006;175(6):2201–6.
Liss M, Skarecky DW, Morales B, et al. Preventing complications of robot-assisted radical prostatectomy. Urology In Press, 2013.
Strasser H, Kima G, Poisel S, et al. Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate. 1996;28:24.
Zvara P, Carrier S, Kour NW, et al. The detailed neuroanatomy of the human striated urethral sphincter. BJUI. 1994;74:182.
•• Tzou DT, Dalkin BL, Christopher BA, Cui H. The failure of nerve sparing template to improve urinary continence after radical prostatectomy: attention to study design. Urologic Onc. 2009;27:358–62. Excellent paper describing the controversy of the scientific method needed to evaluate nerve sparing and return of urinary continence.
Shikanov S, Desai V, Razmaria A, et al. Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after Surgery. J Urol. 2010;183:1803–7.
Pick D, Skarecky DW, Osann K, et al. The impact of cavernosal nerve preservation on continence following robotic radical prostatectomy. BJU 2011;108(9):1492–6
Eastham JA, Kattan MW, Rodgers E, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156:1707–13.
Hammerer P, Huland H. Urodynamic evalutation of changes in urinary control after radical retropubic prostatectomy. J Urol. 1997;157:233–6.
Ahlering TE, Eichel L, Edwards R, Skarecky DW. The impact of body mass and surgical outcomes. Urology. 2005;65(4):740–4.
Teber D, Sofikerim M, Ates M, et al. Is type 2 diabetes mellitus a predictor for incontinence after laparoscopic radical prostatectomy? A matched pair multivariate analysis. J Urol. 2010;183:1087–91.
Novara G, Ficarra V, D’elia C, et al. Evaluating urinary incontinence and preoperative predictors of urinary continence after robotic assisted laparoscopic radical prostatectomy. J Urol. 2010;184:1028–33.
Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer. JAMA. 2000;283(3):354–60.
• Finley D, Chang A, Morales B, et al. Impact of regional hypothermia on urinary continence and potency following robot-assisted radical prostatectomy. J Endourol. 2010;24(7):1111–6. Initial report of continence outcomes with hypothermic cooling.
Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009;37(7):S186–202.
Lee SM, Zhao H, Maier CM, Steinberg GK. The protective effect of early hypothermia on PTEN phosphorylation correlates with free radical inhibition in rat stroke. J Cereb Blood Flow Metab. 2009;29(9):1589–600.
Povlishock JT, Buki A, Koiziumi H, et al. Initiating mechanisms involved in the pathobiology of traumatically induced axonal injury and interventions targeted at blunting their progression. Acta Neurochir Suppl. 1999;73:15–20.
Adachi M, Sohma O, Tsuneishi S, et al. Combination effect of systemic hypothermia and caspase inhibitor administration against hypoxic-ischemic brain damage in neonatal rats. Pediatr Res. 2001;50:590–5.
Ning XH, Chen SH, Xu CS, et al. Hypothermic protection of the ischemic heart via alterations in apoptotic pathways as assessed by gene array analysis. J Appl Physiol. 2002;92:2200–7.
Xu L, Yenari MA, Steinberg GK, et al. Mild hypothermia reduces apoptosis of mouse neurons in vitro early in the cascade. J Cereb Blood Flow Metab. 2002;22:21–8.
Liou AK, Clark R, Henshall DC, et al. To die or not to die for neurons in ischemia, traumatic brain injury and epilepsy: a review on the stress-activated signaling pathways and apoptotic pathways. Prog Neurobiol. 2003;69:103–42.
Chatzipanteli K, Yanagawa Y, Marcillo AE, et al. Posttraumatic hypothermia reduces polymorphonuclear leukocyte accumulation following spinal cord injury in rats. J Neurotrauma. 2000;17:321–32.
Busto R, Dietrich WD, Globus MY, et al. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab. 1987;7:729–38.
Aibiki M, Maekawa S, Ogura S, et al. Effect of moderate hypothermia on systemic and internal jugular plasma IL-6 levels after traumatic brain injury in humans. J Neurotrauma. 1999;16:225–32.
Dietrich WD, Chatzipanteli K, Vitarbo E, et al. The role of inflammatory processes in the pathophysiology and treatment of brain and spinal cord trauma. Acta Neurochir Suppl. 2004;89:69–74.
Suehiro E, Fujisawa H, Akimura T, et al. Increased matrix metalloproteinase-9 in blood in association with activation of interleukin-6 after traumatic brain injury: influence of hypothermic therapy. J Neurotrauma. 2004;21:1706–11.
Hildebrand F, van Griensven M, Giannoudis P, et al. Impact of hypothermia on the immunologic response after trauma and elective surgery. Surg Technol Int. 2005;14:41–50.
Finley D, Osann K, Skarecky DW, Ahlering TE. Hypothermic nerve sparing radical prostatectomy: rationale, feasibility, and impact of early continence. Urology. 2009;73(4):691–6.
Disclosure
A Gordon has no disclosure. T Ahlering is a consultant with Phillips Healthcare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ahlering, T.E., Gordon, A., Morales, B. et al. Preserving Continence During Robotic Prostatectomy. Curr Urol Rep 14, 52–58 (2013). https://doi.org/10.1007/s11934-012-0295-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11934-012-0295-4