4th Annual Jefferson Urology Symposium: Focus on Urinary Incontinence

© The Canadian Journal of Urology TM : International Supplement, August 2021 Management of urinary incontinence following treatment of prostate disease Cassra B. Clark, MD, Victor Kucherov, MD, Edward Kloniecke, MD, Patrick J. Shenot MD, Akhil K. Das MD Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA CLARK CB, KUCHEROV V, KLONIECKE E, SHENOT PJ, DAS AK. Management of urinary incontinence following treatment of prostate disease. Can J Urol 2021;28(Suppl 2):38-43. Introduction: Men who undergo treatment for prostate disease are at increased risk of urinary incontinence (UI). UI has a known negative impact on patient quality of life. Once a thorough evaluation has been performed, there are effective modalities for treatment that can be tailored to the patient. Materials and methods: This review article provides the most recent evidence-based work up and management for men with incontinence after prostate treatment (IPT). Etiology, prophylactic measures, work up, surgical treatments, and patient considerations will be covered. The more recent adjustable balloon device is included in this publication as well as more traditional treatments like the artificial urinary sphincter (AUS) and male urethral sling. Results: IPT can result from treatment of either benign or malignant prostate disease whether surgery or radiotherapy are utilized. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) are all possibilities. SUI after radical prostatectomy (RP) is the most common form of IPT. Patient education and implementation of pelvic therapy as well as modern surgical techniques have greatly improved continence results. AUS remains the gold standard of SUI treatment with the broadest category of patient eligibility. Patients experiencing UUI should be treated according to the overactive bladder guidelines. Conclusions: For men with IPT, it is crucial to first take a thorough patient history and delineate the exact nature of UI symptoms which will determine the options for management. Patient factors and preferences must also be taken into consideration when ultimately choosing the appropriate intervention. Key Words: prostate, prostatectomy, radiotherapy, male incontinence, artificial urinary sphincter, male urethral sling Address correspondence to Dr. Cassra B. Clark, Department of Urology, Thomas Jefferson University, 1025Walnut Street, Suite 1100, Philadelphia, PA 19107 USA Introduction The treatment of prostate disease for both benign and malignant etiology has been associated with an increased risk of urinary incontinence (UI) in men. 1 UI can develop following surgery or radiation therapy (RT) for prostate cancer or after prostate reducing surgeries for benign prostatic hyperplasia 38 (BPH). Types of incontinence include stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. Any incontinence caused by treatment of prostate disease is referred to as incontinence after prostate treatment (IPT). 2 The most common type of IPT is SUI after radical prostatectomy (RP). It is estimated that nearly 200,000 new cases of prostate cancer will occur in 2020. 3 Furthermore, an estimated one third or more of men diagnosed with prostate cancer undergo RP annually. 4 Compared with active surveillance, patients who undergo RP are more likely to experience UI. 5 Long term SUI rates following robotic-assisted laparoscopic