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 the patient.
Sphincter abnormalities following radical prostatectomy are nearly always the result of scarring, Dr. Blaivas said.