References
Post-prostatectomy incontinence: multimodal modern-day management
Abstract
As the rate of prostate cancer detection increases, so does the rate at which radical prostatectomy is performed. Post-prostatectomy incontinence (PPI) or urine leakage affects around 20% of men who undergo this procedure. Although affected individuals must be supported in maintaining hygiene with the use of urine capture devices, definitive treatment should also be offered if appropriate. A range of management options are available, from incontinence pads to artificial urinary sphincters. However, an understanding of the aetiology of the leak as well as patient factors is vital if the correct treatment option is to be selected. This article describes the potential causes of PPI and explores management options for this condition.
Every year, nearly 50 000 men in the UK are newly diagnosed with prostate cancer, and this is the most commonly diagnosed cancer in men (Cancer Research UK, 2018). Radical prostatectomy, which is the surgical removal of the prostate, is a popular treatment option for patients in whom the cancer has not spread beyond the prostate (i.e. the disease is localised). Although curing the cancer is paramount, the survivor's quality of life can be negatively affected by urinary incontinence or erectile dysfunction after a prostatectomy. In order to support men with post-prostatectomy incontinence (PPI), medical and nursing staff should understand the multimodal nature of treatment options, as well as which factors influence successful treatment outcomes and have a low side effect profile.
Most men will experience some urinary leakage immediately after their catheter is removed and in the first months after prostatectomy. Continence improves with time, but usually plateaus at 12 months after surgery (Parker et al, 2011). Long-term PPI rates vary in the literature from 11 to 69%, depending on patient and surgical factors as well as how the incontinence is defined and measured (Wei et al, 2000; Pompe et al, 2017).
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