Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really?

INTRODUCTION: The implications of post-prostatectomy urinary incontinence (PPI) on quality of life pose a matter of great concern for urologists and patients alike. Efforts to mitigate this devastating complication have met with varying degrees of success and the literature has shown a discrepancy between patient- and surgeon-reported outcomes.

AIM: To describe the multifactorial physiology of PPI, its evaluation, and its effect on health-related quality of life and sexual function and to review preoperative predictive factors for PPI and explore the disparity between patient- and surgeon-reported outcomes.

METHODS: We selected a representative sample of principal studies addressing these topics pertaining to PPI. The search was executed by a relevant term search on PubMed from 1994 to the present.

MAIN OUTCOME MEASURES: The main topics of consideration in this review are pathophysiology, predictors and prevalence, and methods of evaluating PPI. We also report on findings on the role of PPI in sexual activity, surgical methods to prevent PPI, and variability in methods of outcome reporting.

RESULTS: The application of various measures to prevent PPI has had variable success and efforts to further refine and widely implement improvements have been complicated by the heterogeneity in measurements used to report and compare outcomes.

CONCLUSION: Patient age, incontinence definitions, and preoperative baseline incontinence make collecting and interpreting urinary function data after radical prostatectomy challenging. Confusion in the literature is compounded by the discrepancy between patient- and surgeon-reported outcomes. On a patient-physician level, there is the issue of potentially under-counseling patients during preoperative discussions on the profound impact of PPI on quality of life in general and on sexual function and satisfaction in particular. Trofimenko V, Myers JB, Brant WO. Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really? Sex Med Rev 2017;5:536-543.