[Prevention of postoperative urinary stress incontinence]

Abstract

Postoperative stress incontinence following operative treatment of prostate cancer represents a considerable percentage of overall male incontinence. Postoperative incontinence following radical prostatectomy ranges between 2.9 and 87% depending on author and patient characteristics. Especially patient-related factors such as body mass index, age, size of prostate, preoperative incontinence, and concomitant diseases as well as classification of incontinence and modality of data collection influence postoperative continence rates. However, recent publications demonstrate the important impact of different operative techniques with regard to postoperative continence.The preservation of the muscular urethral sphincter is of particular importance. Nevertheless, the preservation of further anatomical structures contributes to postoperative continence. Preservation of bladder neck, nerve sparing, and reconstruction of the vesicourethral junction are operative techniques to prevent postoperative incontinence. In the last decade different modifications of the operative technique have been investigated regarding specific effects on postoperative continence. The interpretation of these studies investigating these operative techniques showed improvement in early continence with shorter period of time to continence. Long-term follow-up revealed no significant advantages for these modifications with regard to continence compared to the standard procedure. To evaluate the long-term effects of certain modifications to prevent incontinence, randomized and well powered studies are necessary. It seems to be most likely that a combination of these preventive modifications will lead to improved postoperative continence rates.