Urinary incontinence is a well-known and feared complication after a radical prostatectomy due to its significant impact on the quality of life of patients.
The risk factors for incontinence after a radical prostatectomy are: patient age at the time of surgery, surgical technique, surgeon experience, previous radiotherapy or prior prostate transurethral resection.
Assessment of incontinence
The importance or severity of post-prostatectomy incontinence can be determined by their impact on the quality of life of the patient and the therapeutic possibilities that can be offered.
Most urologists agree that a post-operation follow-up period of at least 12 months is necessary to determine the final degree of incontinence.
Patient assessment begins with a complete and detailed anamnesis. Significant aspects without a description of the type and severity of the incontinence, as well as of its causes. Severity can be determined by the amount of episodes per day, the need and amount of protection, and the impact of incontinence on the patient’s quality of life. The existence of other urinary symptoms such as urgency, an increase in frequency or a decrease in urinary flow must also be taken into account.
An urodynamic study is the only way of carrying out an accurate diagnosis of the aetiology of incontinence. This test is important not only to determine the cause of the incontinence, but also to assess the kind of treatment to be followed. The main goals of the study are to to confirm the existence or non-existence of a dysfunction in the bladder or sphincter and to establish if there is obstruction during urination.
Treatment of post-prostatectomy incontinence varies on a spectrum from conservative to aggressive treatments, and it must be adapted to the individual based on its cause, degree, effect on quality of life and expectations from treatment. Some patients with severe incontinence would be satisfied with changes in their lifestyle and would not require treatment, whereas others who experience minimal losses may demand aggressive treatments.
The artificial sphincter
A series of devices have been designed with the idea of treating urinary incontinence in males since the mid-18th century. Since then, both external devices and internal implants have been manufactured. Today, the artificial sphincter is held to be the gold standard. This device is a hydraulic system with a rotator cuff surrounding the urethra, a balloon that regulates the pressure on the system and an activation pump placed in the scrotum. Artificial sphincters are usually applied in cases of severe urinary incontinence.
On the day after placing the artificial sphincter, a simple abdomen x-ray is carried out to check that the components of the system are correctly located, as well as their disactivation. We also recommend a treatment of orally administered antibiotics for at least one week and the use of a jock strap to prevent scrotal bruises.
Two months after placing the sphincter, it is activated and the patient is taught how to use it correctly. Another simple x-ray is carried out to check the activation of the system.
Complications in the placing of the artificial sphincter can be either mechanical or non-mechanical. Non-mechanical complications include infection, erosion and urethral atrophy, and mechanical complications could result from a leak in the solution that fills the reservoir, the connecting tubes, or a failure in the valve.
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