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Urinary Incontinence After Robotic-assisted Laparoscopic Radical Prostatectomy

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Robotic Urology
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Abstract

This chapter discusses various aspects of urinary incontinence after radical prostatectomy, with specific regard to robotic-assisted laparoscopic radical prostatectomy. The incidence of urinary incontinence following radical prostatectomy is summarized for the various techniques. The primary mechanism of post-radical prostatectomy urinary incontinence, based on urodynamic evidence, is sphincteric dysfunction. Several perioperative risk factors may contribute to urinary incontinence following radical prostatectomy. Age and nerve sparing have the most robust data to support their role in continence outcomes. The evaluation of post-radical prostatectomy incontinence involves a thorough characterization of the incontinence, anatomic evaluation with cystourethroscopy, and a multichannel urodynamic evaluation. Management of urinary incontinence following radical prostatectomy is aimed primarily at treating sphincteric dysfunction. Among the treatment options available, surgical correction of incontinence with a bulbourethral sling or artificial urinary sphincter, depending on the severity of incontinence, are the most effective.

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References

  1. Aboseif SR, O’Connell HE, Usui A, McGuire EJ (1996) Collagen injection for intrinsic sphincteric deficiency in men. J Urol 155:10–13

    Article  PubMed  CAS  Google Scholar 

  2. Ahlering TE, Eichel L, Edwards R, Skarecky DW (2005) Impact of obesity on clinical outcomes in robotic prostatectomy. Urology 65(4):740–744

    Article  PubMed  Google Scholar 

  3. Anger JT, Raj GV, Delvecchio FC, Webster GD (2005) Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management. J Urol 173(4):1143–1146

    Article  PubMed  Google Scholar 

  4. Bader P, Hugonnet CL, Burkhard FC, Studer UE (2001) Inefficient urethral milking secondary to urethral dysfunction as an additional risk factor for incontinence after radical prostatectomy. J Urol 166(6):2247–2252

    Article  PubMed  CAS  Google Scholar 

  5. Bales GT, Gerber GS, Minor TX, Mhoon DA, McFarland JM, Kim HL, Brendler CB (2000) Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology 56(4):627–630

    Article  PubMed  CAS  Google Scholar 

  6. Bianco FJ Jr, Scardino PT, Eastham JA (2005) Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (trifecta). Urology 66(5 Suppl):83–94

    Article  PubMed  Google Scholar 

  7. Burkhard FC, Kessler TM, Fleischmann A, Thalmann GN, Schumacher M, Studer UE (2006) Nerve sparing open radical retropubic prostatectomy: Does it have an impact on urinary continence? J Urol 176(1):189–195

    Article  PubMed  Google Scholar 

  8. Castle EP, Andrews PE, Itano N, Novicki DE, Swanson SK, Ferrigni RG (2005) The male sling for post-prostatectomy incontinence: mean follow-up of 18 months. J Urol 173(5):1657–1660

    Article  PubMed  Google Scholar 

  9. Chan KG, Nelson RA, Crocitto LE, Yoshida JS, Kawachi MH, Wilson TG (2006) Does cavernosal nerve sparing affect urinary continence in laparoscopic and robotic-assisted laparoscopic radical prostatectomy? Poster presented at the 2006 Western Section American Urological Association Meeting

    Google Scholar 

  10. Clemens JQ, Schuster TG, Konnak JW, McGuire EJ, Faerber GJ (2001) Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol 166(4):1372–1375

    Article  PubMed  CAS  Google Scholar 

  11. Coakley FV, Berhardt SE, Kattan MW, Wei DC, Scardino PT, Hricak H (2002) Urinary contin­ence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol 168(3):1032–1035

    Article  PubMed  Google Scholar 

  12. Colombo R, Naspro R, Salonia A, Montorsi F, Raber M, Suardi N, Sacca A, Rigatti P (2006) Radical prostatectomy after previous prostate surgery: clinical and functional outcomes. J Urol 176(6):2459–2463

    Article  PubMed  Google Scholar 

  13. Comiter CV (2002) The male sling for stress urinary incontinence: a prospective study. J Urol 167(2 Pt 1):597–601

    PubMed  Google Scholar 

  14. Comiter CV (2005) The male perineal sling: intermediate-term results. Neurourol Urodyn 24(7):648–653

    Article  PubMed  Google Scholar 

  15. Cummings JM, Boullier JA, Parra RO (1996) Transurethral collagen injections in the therapy of post radical prostatectomy stress incontinence. J Urol 155(3):1011–1013

    Article  PubMed  CAS  Google Scholar 

  16. Dikranian AH, Chang JH, Rhee EY, Aboseif SR (2004) The male perineal sling: comparison of sling materials. J Urol 172(2):608–610

    Article  PubMed  CAS  Google Scholar 

  17. Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC (2003) Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence. J Urol 170(4 Pt 1):1259–1263

    Article  PubMed  CAS  Google Scholar 

  18. Eastham JA, Kattan MW, Rogers V, Goad JR, Ohori M, Boone TB, Scardino PT (1996) Risk factors for urinary incontinence after radical prostatectomy. J Urol 156(5):1707–1713

    Article  PubMed  CAS  Google Scholar 

  19. Elliott, Sand D, Boone TB (2001) Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol 165(2):413–415

    Article  PubMed  CAS  Google Scholar 

  20. Faerber GJ, Richardson TD (1997) Long-term results of transurethral collagen injection in men with intrinsic sphincter deficiency. J Endourol 11(4):273–277

    Article  PubMed  CAS  Google Scholar 

  21. Fassi-Fehri H, Badet L, Cherass A, Murat FJ, Colombel M, Martin X, Gelet A (2006) Efficacy of the InVance trademark male sling in men with stress urinary incontinence. Eur Urol 51(2):498–503

    Article  PubMed  Google Scholar 

  22. Ficazzola MA, Nitti VW (1998) The etiology of post radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol 160(4):1317–1320

    Article  PubMed  CAS  Google Scholar 

  23. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Marzocco M, Tosto A, Nicita G (2005) Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol 48(5):734–738

    Article  PubMed  Google Scholar 

  24. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Villari D, Marzocco M, Nicita G (2007) Pharmacologic treatment in postprostatectomy stress urinary incontinence. Eur Urol 51(6):1559–1664

    Article  PubMed  CAS  Google Scholar 

  25. Goeman L, Salomon L, Taille de la A, Vordos D, Hoznek A, Yiou R, Abbou CC (2006) Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol 24(3):281–288

    Article  PubMed  CAS  Google Scholar 

  26. Gomha MA, Boone TB (2002) Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol 167(2 Pt 1):591–596

    PubMed  Google Scholar 

  27. Hollabaugh RS Jr, Dmochowski RR, Steiner MS (1997) Neuroanatomy of the male rhabdosphincter. Urology 49(3):426–434

    Article  PubMed  Google Scholar 

  28. John H (2004) Bulbourethral composite suspension: a new operative technique for post-prostatectomy incontinence. J Urol 171(5):1866–1870

    Article  PubMed  Google Scholar 

  29. John H, Sullivan MP, Bangerter U, Hauri D, Yalla SV (2000) Effect of radical prostatectomy on sensory threshold and pressure transmission. J Urol 163(6):1761–1766

    Article  PubMed  CAS  Google Scholar 

  30. Kaufman JJ (1972) Surgical treatment of post-prostatectomy incontinence: use of the penile crura to compress the bulbous urethra. J Urol 107:293–297

    PubMed  CAS  Google Scholar 

  31. Kleinhans B, Gerharz E, Melekos M, Weingartner K, Kalble T, Riedmiller H (1999) Changes of urodynamic findings after radical retropubic prostatectomy. Eur Urol 35(3):217–222

    Article  PubMed  CAS  Google Scholar 

  32. Klijn AJ, Hop WC, Mickisch G, Schroder FH, Bosch JL (1998) The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates. Br J Urol 82(4):530–533

    PubMed  CAS  Google Scholar 

  33. Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ (2004) Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 172(6 Pt 1):2227–2231

    Article  PubMed  Google Scholar 

  34. Leach GE, Trockman B, Wong A, Hamilton J, Haab F, Zimmern PE (1996) Post-prostatectomy incontinence: urodynamic findings and treatment outcomes. J Urol 155(4):1256–1259

    Article  PubMed  CAS  Google Scholar 

  35. Lee SE, Byun SS, Lee HJ, Song SH, Chang IH, Kim YJ, Gill MC, Hong SK (2006) Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy. Urology 68(1):137–141

    Article  PubMed  Google Scholar 

  36. Lepor H, Kaci L (2004) 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 171 (3):1216–1219

    Article  PubMed  Google Scholar 

  37. Litwiller SE, Kim KB, Fone PD, White RW, Stone AR (1996) Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success. J Urol 156(6):1975–1980

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  39. Malizia AA Jr, Reiman HM, Myers RP, Sande JR, Barham SS, Benson RC Jr, Dewanjee MK, Utz WJ (1984) Migration and granulomatous reaction after periurethral injection of polytef (Teflon). J Am Med Assoc 251(24):3277–3281

    Article  Google Scholar 

  40. Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO (2006) Vattikuti Institute Prostatectomy: contemporary technique and analysis of results. Eur Urol 51(3):648–657

    Article  PubMed  Google Scholar 

  41. Migliari R, Pistolesi D, DeAngelis M (2003) Polypropilene sling of the bulbar urethra for post radical prostatectomy incontinence. Eur Urol 43(2):152–157

    Article  PubMed  CAS  Google Scholar 

  42. Migliari R, Pistolesi D, Leone P, Viola D, Trovarelli S (2006) Male bulbourethral sling after radical prostatectomy: intermediate outcomes at 2 to 4-year follow-up. J Urol 176(5):2114–2118

    Article  PubMed  Google Scholar 

  43. Millard RJ, Moore K, Rencken R, Yalcin I, Bump RC (2004) Duloxetine vs placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial. BJU Int 93(3):311–318

    Article  PubMed  CAS  Google Scholar 

  44. Narayan P, Konety B, Aslam K, Aboseif S, Blumenfeld W, Tanagho E (1995) Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol 153(2):337–341

    Article  PubMed  CAS  Google Scholar 

  45. Oefelein MG (2004) Prospective predictors of urinary continence after anatomical radical retro­pubic prostatectomy: a multivariate analysis. World J Urol 22(4):267–271

    Article  PubMed  Google Scholar 

  46. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S (2003) The role of pelvic floor exercises on post-prostatectomy incontinence. J Urol 170(1):130–133

    Article  PubMed  CAS  Google Scholar 

  47. Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community setting – the learning curve and beyond: initial 200 cases. J Urol 174(1):269–272

    Article  PubMed  Google Scholar 

  48. Pfister C, Cappele O, Dunet F, Bugel H, Grise P (2002) Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinence. Neurourol Urodyn 21(3):194–197

    Article  PubMed  Google Scholar 

  49. Rajpurkar AD, Onur R, Singla A (2005) Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol 47(2):237–242

    Article  PubMed  Google Scholar 

  50. Sacco E, Prayer-Galetti T, Pinto F, Fracalanza S, Betto G, Pagano F, Artibani W (2006) 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 97(6):1234–1241

    Article  PubMed  Google Scholar 

  51. Schaeffer AJ, Clemens JQ, Ferrari M, Stamey TA (1998) The male bulbourethral sling procedure for post radical prostatectomy incontinence. J Urol 159(5):1510–1515

    Article  PubMed  CAS  Google Scholar 

  52. Schlossberg S, Jordan G, Schellhammer P (1995) Repair of obliterative vesicourethral stricture after radical prostatectomy: a technique for preservation of continence. Urology 45(3):510–513

    Article  PubMed  CAS  Google Scholar 

  53. Smith DN, Appell RA, Rackley RR, Winters JC (1998) Collagen injection therapy for post-prostatectomy incontinence. J Urol 160(2):364–367

    Article  PubMed  CAS  Google Scholar 

  54. Stern JA, Clemens JQ, Tiplitsky SI, Matschke HM, Jain PM, Schaeffer AJ (2005) Long-term results of the bulbourethral sling procedure. J Urol 173(5):1654–1656

    Article  PubMed  Google Scholar 

  55. Thor KB, Katofiasc MA (1995) Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neural control of lower urinary tract function in the chloralose-anesthetized female cat. J Pharmacol Exp Ther 274(2):1014–1024

    PubMed  CAS  Google Scholar 

  56. Twiss C, Slova D, Lepor H (2005) Outcomes for men younger than 50 years undergoing radical prostatectomy. Urology 66(1):141–146

    Article  PubMed  Google Scholar 

  57. van Kerrebroeck P, Abrams P, Lange R, Slack M, Wyndaele JJ, Yalcin I, Bump RC (2004) Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. Br J Obstet Gynecol 111(3):249–257

    Google Scholar 

  58. Walsh IK, Williams SG, Mahendra V, Nambirajan T, Stone AR (2002) Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction. BJU Int 89(4):364–368

    Article  PubMed  CAS  Google Scholar 

  59. Wessells H, Morey AF, McAninch JW (1998) Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium. J Urol 160(4):1373–1375

    Article  PubMed  CAS  Google Scholar 

  60. Westney OL, Bevan-Thomas R, Palmer JL, Cespedes RD, McGuire EJ (2005) Transurethral collagen injections for male intrinsic sphincter deficiency: the University of Texas–Houston experience. J Urol 174(3):994–997

    Article  PubMed  Google Scholar 

  61. Wille S, Heidenreich A, Knobloch R von, Hofmann R, Engelmann U (2006) Impact of comorbidities on post-prostatectomy incontinence. Urol Int 76(3):223–226

    Article  PubMed  CAS  Google Scholar 

  62. Wille S, Sobottka A, Heidenreich A, Hofmann R (2003) Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: results of a prospective randomized trial. J Urol 170(2 Pt 1):490–493

    Article  PubMed  CAS  Google Scholar 

  63. Wiygul JB, Harris MJ, Dahm P (2005) Early patient self-assessed outcomes of nerve-sparing radical perineal prostatectomy. Urology 66(3):582–586

    Article  PubMed  Google Scholar 

  64. Keller H, Lehmann J, Beier J (2007) Radical perineal prostatectomy and simultaneous extended pelvic lymph node dissection via the same incision. Eur Urol 52(2):384−388

    Article  PubMed  Google Scholar 

  65. Harris MJ (2007) The anatomic radical perineal prostatectomy: an outcomes-based evolution. Eur Urol 52(1):81−88

    Article  PubMed  Google Scholar 

  66. Curto F, Benijts J, Pansadoro A, Barmoshe S, Hoepffner JL, Mugnier C, Piechaud T, Gaston R (2006) Nerve sparing laparoscopic radical prostatectomy: our technique. Eur Urol 49(2):344−352

    Article  PubMed  CAS  Google Scholar 

  67. Rassweiler J, Stolzenburg J, Sulser T, Deger S, Zumbe J, Hofmockel G, John H, Janetschek G, Fehr JL, Hatzinger M, Probst M, Rothenberger KH, Poulakis V, Truss M, Popken G, Westphal J, Alles U, Fornara P (2006) Laparoscopic radical prostatectomy: the experience of the German Laparoscopic Working Group. Eur Urol 49(1):113−119

    Article  PubMed  Google Scholar 

  68. Joseph JV, Rosenbaum R, Madeb R, Erturk E, Patel HR (2006) Robotic extraperitoneal radical prostatectomy: an alternative approach. J Urol 175(3 Pt 1):945−950

    Article  PubMed  CAS  Google Scholar 

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Chan, K., Wilson, T. (2008). Urinary Incontinence After Robotic-assisted Laparoscopic Radical Prostatectomy. In: John, H., Wiklund, P. (eds) Robotic Urology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-74140-4_12

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  • DOI: https://doi.org/10.1007/978-3-540-74140-4_12

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