Pathophysiologic Mechanisms in Postprostatectomy Urinary Incontinence

  • Joseph LaBossiere
  • Sender Herschorn


Urinary incontinence is a common and debilitating complication after radical prostatectomy (RP). Though the majority of men will experience significant improvement in continence, up to 5% of men will ultimately have surgery to correct persistent incontinence. A fundamental understanding of the pathophysiologic mechanisms involved in postprostatectomy incontinence may aid the urologist in preoperative counseling and prognostication and guide intraoperative decision-making and choice of surgical technique as well as in selecting appropriate treatment option(s) for persistent postprostatectomy incontinence. Our understanding of the factors influencing postprostatectomy incontinence continues to evolve. Many studies have demonstrated the impact of surgical/anatomical factors on postprostatectomy incontinence including the status of the external urethral sphincter, bladder neck preservation or repair, preservation of the neurovascular bundles, postoperative membranous urethral length, and reconstruction of periurethral support structures. Patient factors such as age and body mass index as well as biologic factors including preoperative membranous urethral length, prostate size, pre-existing lower urinary tract symptoms, and the presence of bladder dysfunction have also been implicated. Investigation into surgical techniques that may impact on continence rates (bladder neck sparing, periurethral reconstruction, and the use of robotic-assisted technology) is currently ongoing.


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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.University of TorontoTorontoCanada

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