Improving urinary continence after radical prostatectomy: Review of surgical modifications

Abstract

Purpose: Urinary incontinence remains the most feared long-term complication following radical prostatectomy with potentially devastating psychosocial consequences. In recent years, several surgical techniques have been introduced during radical prostatectomy, both open and laparoscopic/ robotic, in the hope of improving urinary continence outcomes. Herein, we review the various surgical modifications that have shown a benefit in minimizing post-prostatectomy urinary incontinence (PPI). Materials and Methods: A comprehensive review of the current urologic literature was conducted to identify surgical techniques that have been correlated with improved continence following radical prostatectomy. Results: Over the years, several surgical modifications have been incorporated into radical prostatectomy in order to minimize the risk of prolonged PPI. Most techniques emphasize the importance of restoring the "normal" pelvic anatomy after removal of the prostate gland. In addition, certain patient factors such as preoperative posterior urethral length and patient age appear to have an independent prognostic value in predicting PPI. Postoperatively, bladder neck contracture remains the most consistent complication leading to PPI. Conclusions: The present findings suggest that the risk of PPI can be minimized, or even eliminated, through careful patient selection and surgical modifications during radical prostatectomy. ©The Korean Urological Association, 2009.