Urinary Incontinence Post Prostatic Surgery
description
Transcript of Urinary Incontinence Post Prostatic Surgery
Dr. Abdullah Ahmad Ghazi (R5)KSMC
19-12-1432
Estimated as:5-69% of women1-39% of men.
Age. LUTS. Infection. Functional and cognitive impairment. Neurological disorders. Prostatectomy.
Sphincter-relatedPostoperative
Post-prostatectomy for benign disease Post-prostatectomy for prostate cancer Post radiotherapy, brachytherapy, cryosurgery,
HIFU for prostate cancer Post cystectomy and neobladder for bladder
cancerPost-traumatic
After prostato-membranous disruption and urethral reconstruction
Pelvic floor traumaUnresolved paediatric UIExstrophy and incontinent epispadias
Bladder-relatedRefractory UUI (overactive bladder)Reduced capacity bladder
FistulaeUrethro-cutaneousRecto-urethral
Hx Ex Urine analysis PVR Voiding diary. Pad test. Renal profile. U.cystoscopy. Image (U/S, VCUG, IVP). UDS.
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.
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.
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.
How long to wait ?
Artificial urinary sphincter (AUS) success rate 59-90%.
Male slings 58%.Bulking agents, early failure 50%.
Cognitive impairment.
Dexterity restriction.
?
Risk is 0-18.9%, increase with time.
More as adjuvant therapy, or Hx of TURP.
AUS post XRT associated with more complications.
Perineal compression slings (limited evidence).
Injectable agents (not successful).
Brachytherapy 0-45%. Cryotherapy 0-5%. HIFU
Rx: AUR Injectable material not successful.
Cause of incontinence after AUS:
Alteration in bladder function.Urethral atrophy.Mechanical malfunction.