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Office Evaluation for Post-prostatectomy Incontinence

  • Hin Yu Vincent Tu
  • Jaspreet S. Sandhu
Chapter

Abstract

The first step in the management of post-prostatectomy urinary incontinence (PPI) begins with a detailed history, including characteristics of the incontinence, patient expectations, as well as demographic variables such as the patient’s age [1]. This can help put the patient’s overall health status and long-term continence goals into context. The time since the radical prostatectomy should be ascertained as multiple studies have shown that it may take up to 1 year for most men to regain continence [2, 3]. As such, surgical therapy is typically deferred until after the first postoperative year for persistent urinary incontinence [4]. Recent evidence suggests that if patients have significant incontinence at 6 months, they are unlikely to recover, suggesting that surgical therapy may be considered as early as 6 months [5]. Preoperative factors such as obesity [6], preexisting incontinence, previous transurethral resection of the prostate (TURP), and prior radiation therapy [7] have been shown to be risk factors for post-prostatectomy incontinence. Furthermore, surgical factors such as the approach to the radical prostatectomy, whether open, laparoscopic, or robotic [8–11], and nerve-sparing status [12–14] are also important to clarify. Oncologic status, including PSA value, can help inform the urologist about the timing to potential anti-incontinence surgery in the event the patient should require further treatment for locally recurrent or metastatic disease [1]. Prior history of pelvic radiation and surgery, including prostate and bladder procedures, should be well documented. Finally, all medications that can affect the urinary tract should be reviewed, especially alpha-adrenergic blockers, anticholinergic agents, and beta-3 agonists.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Surgery, Urology ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA

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