PHILADELPHIA--Urinary incontinence probably occurs as a complication
of radical prostatectomy more often than series reported in the
literature suggest, said Jerry G. Blaivas, MD, in a panel discussion
of complications of prostate cancer held at the American Cancer
Society's National Conference on Prostate Cancer.
Dr. Blaivas, clinical professor of urology, New York Hospital,
presented an approach for managing the relatively easily treated
causes of early incontinence, as well as the more difficult evaluation
and treatment of persistent incontinence.
Urinary incontinence following radical prostatectomy is often
a transitory problem that can be easily treated if a reversible
cause is identified, or that may resolve spontaneously, Dr. Blaivas
said. Persistent problems can be managed with a variety of approaches,
including drugs, biofeedback, and the implantation of a sphincter
prosthesis; the choice depends on the underlying pathology and
the patient's preference.
Urinary incontinence can stem from either a bladder abnormality
or a sphincter abnormality. Detrusor overactivity, leading to
involuntary contractions of the bladder, is most often caused
in the post-prostatectomy patient by urinary tract infection or
a retained suture, Dr. Blaivas said.
Possible Unrelated Causes
Other potential causes of detrusor overactivity that are unrelated
to prostate surgery, such as bladder stones, low bladder compliance,
or carcinoma of the bladder, should be investigated before treating
Sphincter abnormalities following radical prostatectomy are nearly
always the result of scarring, Dr. Blaivas said.