[Urinary incontinence after radical prostatectomy: surgical technique historic evolution and present functional outcomes].

OBJECTIVES

In patients with localized prostate cancer and life expectancy longer than 10 years, radical prostatectomy (RP) remains the Gold Standard. Radical surgery must achieve good oncological and functional outcomes with early continence and potency. In expert hands RP offers very low post-prostatectomy urinary incontinence rates. To analyze functional outcomes regarding urinary incontinence (UI) after RP in our centre in the last ten years.

METHODS

We have performed a retrospective study of the 137 patients who had a radical prostatectomy (open retropubic or laparoscopic) on the General University Hospital of Elche from 1998 to 2008. Two patient groups were analyzed, patients who had surgery from 1998 to 2003, and those who had surgery from 2004 to 2008. Stress UI rates after RP were determined in both groups at 1, 3, 6 and 12 months following surgery with patient pad day usage. Urethrovesical anastomosis strictures were also analyzed in each group and their resolution.

RESULTS

15 patients were excluded from the initial 137 because cT3 stage was detected, remaining 122 prostatectomies with <cT2c stage in the study. Average age was 67 years (50-74). Mean preoperative PSA was 8.1 ng/ml (4.5-25). Biopsy Gleason score was < 6 in 70% (85/122) and 7-8 in 30 % (37/122). In the period between 1998 and 2003, 49 patients underwent surgery and results were: initially continent 28.5% (14/49), continent after one month: 6.1% (3/49), at 3 months: 12.2% (6/49), six months 8.1% ( 4/49) and at a year: 22.4%(11/49). 20.4% (10/49) remain with mild incontinence and moderate/severe 2% (1/49). In this period 78% of the patients remain continent and 22% incontinent. In the period 2004-2008, 73 radical prostatectomies were performed with the following continence rates: initial continence 44% (32/73), after one month 0 patients, 3 months 6.8 % (5/73), 6 months 12.3 % (9/73), a year later 24.6 % (18/73). Mild incontinence was observed in 8.2% ( 6/73) and moderate-severe in 4% (3/73). 88% of the patients achieved continence and 12% remain incontinent.

CONCLUSIONS

Urinary incontinence is a low frequency disorder in patients who undergo RP. Continence rates have been improving during the last years along with surgical technique and urologic expertise. Anti-incontinence devices after PR are rarely necessary and use is overrated.