3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 Male urinary incontinence after prostate disease treatment Akhil K. Das, MD,Victor Kucherov, MD, Lydia Glick, BS, Paul Chung, MD Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA DAS AK, KUCHEROV V, GLICK L, CHUNG P. Male urinary incontinence after prostate disease treatment. Can J Urol 2020;27(Suppl 3):36-43. Introduction: Incontinence after prostate treatment (IPT) is an important and common problem for men and can lead to decreased quality of life. The proper evaluation and management of IPT requires both knowledge of the mechanisms for its development and of multiple evolving therapy types. Materials and methods: An update is provided on the evaluation and management for IPT. The underlying pathophysiology of the contributing conditions is explored along with the appropriate assessment prior to therapy. Surgical techniques including the artificial urinary sphincter (AUS) and male urethral sling are detailed specifically and compared. Results: IPT can result from radical prostatectomy (RP), prostate radiation, and surgery for benign prostatic hyperplasia. All of these may increase the risk for stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed incontinence. SUI after RP remains the largest component of IPT. Perioperative pelvic floor muscle therapy and advances in surgical technique have helped to prevent and treat post-RP SUI. The AUS and male urethral sling are both excellent surgical options for SUI with the AUS being currently indicated for a broader set of patients. Predominant UUI should be treated in a stepwise manner based upon guidelines for overactive bladder. Conclusions: Evaluation of men with IPT should include determining components of SUI and UUI as these will direct medical and surgical therapy. While advances in surgical technique and technology have reduced prevalence of SUI after RP, manymen still require treatment. Surgical treatments with AUS and male urethral sling provide excellent outcomes in well selected patients. Key Words: male incontinence, artificial urinary sphincter, male urethral sling Address correspondence to Dr. Akhil K. Das, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 1110, Philadelphia, PA 19107 USA Introduction Urinary incontinence (UI) of all kinds increases the risk for anxiety and depression and is associated with lower healthcare related quality of life. 1 Reasons for UI are many-fold and particular attentionmust be paid to those that develop in the setting of treatment of other conditions. Such is the case for men who develop UI after surgical treatment for prostate cancer, from prostate radiation therapy (RT), and from surgery for benign prostatic hyperplasia (BPH). These types of incontinence as a group are termed incontinence after prostate treatment (IPT). 2 IPT as a definition is inclusive of all types of UI including stress urinary incontinence (SUI), urge urinary 36 incontinence (UUI), and mixed incontinence. SUI after radical prostatectomy (RP) is the most common and significant component. Menwith prostate cancer are at a 4-fold increased risk for UI after RP when compared to watchful waiting. 3 Recent data suggest an average long term SUI rate after robot-assisted laparoscopic prostatectomy (RALP) of 8%-16% with variability based upon SUI definition, surgical technique, and skill level. 4,5 Pelvic floor muscle therapy (PFMT) in the perioperative setting and advances in RP surgical techniques have been shown to improve continence rates over time. 4,6 However, many men still develop symptoms bothersome-enough to seek intervention. In this paper we provide a review and update of the evaluation and management for IPT. The underlying pathophysiology of the components of IPT is explored in addition to preventive measures (surgical and non- surgical) that have been popularized. Surgical therapy for male SUI is highlighted including the artificial urinary sphincter (AUS) and male urethral sling.