TY - JOUR
T1 - How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?
T2 - International Consultation on Incontinence-Research Society 2018
AU - Averbeck, Marcio A
AU - Marcelissen, Tom
AU - Anding, Ralf
AU - Rahnama'i, Mohammad S
AU - Sahai, Arun
AU - Tubaro, Andrea
N1 - © 2019 Wiley Periodicals, Inc.
PY - 2019/12
Y1 - 2019/12
N2 - AIMS: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP).METHODS: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?"RESULTS: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP.CONCLUSIONS: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
AB - AIMS: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP).METHODS: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?"RESULTS: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP.CONCLUSIONS: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
KW - prevention
KW - radical prostatectomy
KW - urinary incontinence
KW - LAPAROSCOPIC RADICAL PROSTATECTOMY
KW - RANDOMIZED CLINICAL-TRIAL
KW - BLADDER NECK PRESERVATION
KW - CONTINENCE RECOVERY
KW - SLING SUSPENSION
KW - EARLY RETURN
KW - SHORT-TERM
KW - RECONSTRUCTION
KW - PREDICTORS
KW - IMPACT
U2 - 10.1002/nau.23972
DO - 10.1002/nau.23972
M3 - (Systematic) Review article
C2 - 31821626
SN - 0733-2467
VL - 38
SP - S119-S126
JO - Neurourology and Urodynamics
JF - Neurourology and Urodynamics
IS - Suppl 5
ER -