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Urinary Incontinence Post Prostatic Surgery

Urinary Incontinence Post Prostatic Surgery. Dr. Abdullah Ahmad Ghazi (R5) KSMC 19-12-1432. Incidence. Estimated as: 5-69% of women 1-39% of men. Risk Factor of UI in Men. Age. LUTS. Infection. Functional and cognitive impairment. Neurological disorders. Prostatectomy. Aetiology.

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Urinary Incontinence Post Prostatic Surgery

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  1. Urinary Incontinence Post Prostatic Surgery Dr. Abdullah Ahmad Ghazi (R5) KSMC 19-12-1432

  2. Incidence • Estimated as: • 5-69% of women • 1-39% of men.

  3. Risk Factor of UI in Men • Age. • LUTS. • Infection. • Functional and cognitive impairment. • Neurological disorders. • Prostatectomy.

  4. Aetiology • Sphincter-related • Postoperative • Post-prostatectomy for benign disease • Post-prostatectomy for prostate cancer • Post radiotherapy, brachytherapy, cryosurgery, HIFU for prostate cancer • Post cystectomy and neobladder for bladder cancer • Post-traumatic • After prostato-membranous disruption and urethral reconstruction • Pelvic floor trauma • Unresolved paediatric UI • Exstrophy and incontinent epispadias

  5. Aetiology • Bladder-related • Refractory UUI (overactive bladder) • Reduced capacity bladder • Fistulae • Urethro-cutaneous • Recto-urethral

  6. Assessment • Hx • Ex • Urine analysis • PVR • Voiding diary. • Pad test. • Renal profile. • U.cystoscopy. • Image (U/S, VCUG, IVP). • UDS.

  7. Post prostatic surgery UI • BPH • Incidence of UI is similar after (TURP, TUIP, Holium enucleation and open surgery). • Pr Ca • Reported 5-48%. • Assessed by: • Numbers of pads and their wetness. • Social impairment. • Bothersomeness.

  8. Definitions of post-RP continence • Total control without any pad. • Leakage: • No pad but loss of few drops of urine ‘underwear staining’. • None or 1 pad ‘safety pad’ per day.

  9. Risk factors • Age at surgery. • Prostate size. • Co-morbidity. • Nerve sparing surgery. • Bladder neck stenosis. • Tumour stage (possibly related to surgical technique) • Preoperative bladder and sphincter dysfunction.

  10. Interventional treatment for post-RP incontinence • How long to wait ? • Artificial urinary sphincter (AUS) success rate 59-90%. • Male slings 58%. • Bulking agents, early failure 50%.

  11. C/I to AUS • Cognitive impairment. • Dexterity restriction.

  12. UI with bladder neck contracture/urethral stricture ?

  13. UI after XRT • Risk is 0-18.9%, increase with time. • More as adjuvant therapy, or Hx of TURP. • AUS post XRT associated with more complications.

  14. Other treatment after XRT • Perineal compression slings (limited evidence). • Injectable agents (not successful).

  15. Incontinence after other treatment for CaP • Brachytherapy 0-45%. • Cryotherapy 0-5%. • HIFU • Rx: AUR • Injectable material not successful.

  16. Complication of AUS • Cause of incontinence after AUS: • Alteration in bladder function. • Urethral atrophy. • Mechanical malfunction.

  17. Thank you for your attention

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