Preoperative assessment and intervention: Optimizing outcomes for early return of urinary continence

Abstract

Spontaneous recovery of urinary incontinence is generally to be expected within 3–24 months after radical prostatectomy. The reason for this interindividual variability cannot be only explained by the surgical approach and technique. Several studies have, however, elucidated numerous preoperative patient- and tumor-related factors that influence early return of continence in the postoperative period. Age, performance status, body mass index, physical activity, erectile function, and urodynamic parameters were found to be valid predictor factors of continence recovery after radical prostatectomy. Membranous urethral length and shape of the prostatic apex were the most studied anatomical interindividual variations related to recovery time and level of urinary continence after radical prostatectomy. Tumor-related factors contribute as well, to a lesser degree, to the recovery of postradical prostatectomy incontinence. The evidence of the clinical utility of various preoperative assessment techniques was also summarized as well as preoperative interventions aimed to enhance regain of continence.