Pathophysiology of Post-prostatectomy Urinary Incontinence and Current Treatment Approaches

Abstract

Radical prostatectomy, is the gold standard modality in the treatment of organ confined prostate cancer. Urinary incontinence is one of the most bothersome complication after RP and several factors such as, surgical technique, patient age, nerve-sparing and anastomosis technique play role in the pathogenesis. Management of incontinence due to prostatectomy includes several methods which differ from conservative to invasive methods. Pelvic floor exercises, pharmacological agents, collagen injection, sling surgeries, adjustable methods, artificial urinary sphincter and new modalities are among these. In this review, anatomical and pathophysiological factors in the development of post-prostatectomy incontinence, as well as current treatment modalities are reviewed. ©2008, Fırat Üniversitesi, Tıp Fakültesi

Keywords

• -

Radikal Prostatektomi Sonrası Oluşan İdrar Kaçırma Patogenezi ve Güncel Tedavi Yaklaşımları

Öz

Organa sınırlı prostat kanserinde altın standart tedavi seçeneği radikal prostatektomidir. RP sonrası en önemli komplikasyonlardan biri idrar kaçırma olup cerrahi teknik, hasta yaşı, sinir-koruyucu uygulama ve anastamoz tekniği gibi pek çok faktör patogenezde rol oynayabilir. Prostatektomi sonrası oluşan idrar kaçırma tedavisi, konservatif yöntemlerden invaziv girişimlere kadar değişen farklı metodlar kullanılarak yapılmaktadır. Pelvik taban egzersizleri, farmakolojik ajanlar, kollajen enjeksiyonu, sling cerrahisi, ayarlanabilir teknikler, artifisyel sfinkter ve yeni geliştirilen yöntemler tedavideki bazı uygulamalardır. Bu çalışmada, Radikal prostatektomi sonrası oluşan idrar kaçırmada anatomik ve patofizyolojik faktörler ile tedavide uygulanan güncel yöntemler gözden geçirilmiştir.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Radikal prostatektomi, idrar kaçırma, tedavi, cerrahi

Kaynakça

1. Walsh PC: Anatomic Radical Retropubic Prostatectomy; in Walsh PC, Retik AB, Vaughan ED, Wein AJ(Eds.): Campbell’s Urology 7. baskı, 1998: 2565-2588.
2. Herr HW. Quality of life of incontinent men after radical prostatectomy. J Urol 1994; 151: 652-654.
3. Litwin MS, Hays RD, Fink A, et al: Quality of life outcomes in men treated for localized prostate cancer. JAMA 1995; 273: 129- 135
4. Kao T-C, Cruess DF, Garner D, et al: Multicenter patient self- reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol 2000; 163: 858-864.
5. Carlson KV, Nitti VW: Prevention and management of incontinence following radical prostatectomy. Urol Clin N Amer 2001; 28: 595-612.
6. Burnett AL, Mostwin JL: In situ anatomical study of the male urethral sphincter complex: Relevance to continence preservation following major pelvic surgery. J Urol 1998; 160: 1301-1306.
7. Myers RP: Male Urethral sphincter anatomy and radical prostatectomy. Urol Clin N Amer 1991; 18: 211-227.
8. Steiner MS: Anatomic basis for the continence-preserving radical retropubic prostatectomy. Sem Urol Oncol 2000; 18: 9-18.

9. Hollabaugh RS, Dmochowski RR, Kneib TG, et al: Preservation of putative continence nerves during radical retropubic prostatectomy leads to kore rapid return of urinary incontinence. Urology 1998; 51: 960-967.
10. Gosling JA, Dixon JS, Critchley HOD, et al: Comparative study of the human external sphincter and periurethral levator ani muscles. Br J Urol 1981; 53: 35-41.
11. Leach GE, Yip CM, Donovan BJ: Post prostatectomy incontinence: The influence of bladder dysfunction. J Urol 1987; 138: 574-578.
12. Groutz A, Blaivas JG, Chaikin DC, et al: The pathophysiology of post-radical prostatectomy incontinence: A clinical and video urodynamic study. J Urol 2000; 163: 1767-1770.
13. Ficazzola MA, Nitti VW: The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol 1998; 160: 1317-1320.
14. Mostwin JL: Urinary incontinence [editorial]. J. Urol 1995; 151: 352-353.
15. Hellstrom P, Lukkarinen O, Kontturi M: Urodynamics in radical retropubic prostatectomy. Scand J Urol Nephrol 1989; 23: 21-24.
16. Foote J, Yun S, Leach GE: Post prostatectomy incontinence: Pathophysiology, evaluation and management. Urol Clin N Amer 1991; 18: 229-241.
17. Zimmern PE, Leach GE: Treatment of incontinence in men. Semin Urol 1989; 7: 124-132.
18. Catalona WJ, Carvalhal GF, Mager DE, et al: Potency, continence and complication rates in 1870 consecutive radical retropubic prostatectomies. J Urol 1999; 162: 432-438.
19. Eastham JA, Kattan MW, Rogers E, et al: Risk factors for urinary incontinence after radical prostatectomy. J Urol 1996; 156: 1707-1713.
20. Jonler M, Messing EM, Rhodes PR, et al: Sequela of radical prostatectomy. Br J Urol 1994; 74: 352-358.
21. Wei JT, Montie JE: Comparison of patients’ and physicians’ ratings of urinary incontinence following radical prostatectomy. Semin Urol Oncol 2000; 18: 76-80.
22. O’Donnell PD, Finan BF: Continence following nevre-saparing radical prostatectomy. J Urol 1989; 142: 1227-1228.
23. Walsh PC, Partin AW, Epstein JI: Cancer control and quality of life following anatomical radical retropubic prostatectomy: Results at 10 years. J Urol 1994; 152: 1831-1836.
24. Leach GE, Yun SK: Post-prostatectomy incontinence. Part II. The results of treatment based on urodynamic evaluation. Neurourol Urodyn 1992; 11: 99-106.
25. Nitti VW, Combs AJ: Urodynamics: When, why and how. In Nitti VW (ed): Practical Urodynamics: Philadelphia, 1998; 38-51.
26. Srikrishna S, Robinson D, Cardozo L, et al: Management of overactive bladder syndrome. Postgrad Med J 2007; 83: 481-486.
27. Kuo H: Urodynamic evidence of effectiveness of Botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents. Urology 2004; 63: 868-872.
28. Schmidt RA, Jonas U, Oleson KA, et al: Sacral nevre stimulation for treatment of refractory urinary urge incontinence. Sacral nevre stimulation study group. J Urol 1999; 162: 352-357.
29. Mark SD: Clam cystoplasty fort he overactive bladder: a review of 23 cases. Aust N Z J Surg 1994; 64: 88-90.
30. Karsenty G, Vidal F, Ruffion A, et al: Treatment of neurogenic detrusor hyperactivity: detrusor myomectomy. Prog Urol 2007; 17: 580-583.
31. Filocamo MT, Li Marzi V, Popolo GD, et al: Effectiveness of early pelvic flor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol 2005; 48: 734-738.
32. Yokoyama T, Nishiguchi J, Watanabe T, et al: Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy. Urology 2004; 63: 264-267.
33. Jost WH, Marselek P, Manning M, et al: Pharmaceutical treatment of stress incontinence. New approaches via direct effect of duloxetine on Onuf’s nucleus. Urologe A 2004; 43: 1249- 1253.
34. Schlenker B, Gratzke C, Reich O, et al: Preliminary results on the off-label use of duloxetine fort he treatment of stress incontinence after radical prostatectomy or cystectomy. Eur Urol 2006; 49: 1075-1078.
35. Chapple CR: Duloxetine for male stress incontinence [editorial]. Eur Urol 2006; 49: 958-960.
36. Smith DN, Appell RA, Rackley RR, et al: Collagen injection therapy for post-prostatectomy incontinence. J Urol 1998; 160: 364-367.
37. Griebling TL, Kreder KJ, Williams RD: Transurethral collagen injection for treatment of postprostatectomy urinary incontinence in men. Urology 1997; 49: 907-912,
38. Faerber GJ, Richardson TD: Long-term results of transurethral collagen injection in men with intrinsic sphincter deficiency. J Endourol 1997; 11: 273-277.
39. Bevan-Thomas R, Wesley OL, Cespedes RD, et al: Long term followup of periurethral collagen injections for male intrinsic deficiency. J Urol 1999; 161: 257A,
40. Appell RA, Vasavada SP, Rackley RR, et al: Percutaneous antegrade collagen injection therapy for urinary incontinence following radical prostatectomy. Urology. 1996; 48: 769-772.
41. Wainstein MA, Klutke CG: Antegrade techniques of collagen injection for post-prostatectomy stress urinary incontinence: the Washington University experience. W J Urol 1997; 15: 310-315.
42. Martins FE, Bennett CJ, Dunn M, et al: Adverse prognostic features of collagen injection therapy for urinary incontinence following radical retropubic prostatectomy. J Urol 1997; 158: 1745-1748.
43. Triaca V, Twiss CO, Raz S: Urethral compression fort he treatment of postprostatectomy incontinence: Is history repeating itself? Eur Urol 2007; 51: 304-305. 44. Kaufman JJ: Surgical treatment incontinence: Use of the penile crura to compress the bulbous urethra. J Urol 1972; 107: 293-297. of postprostatectomy
44. Kaufman JJ, Raz S: Urethral compression procedure fort he treatment of male urinary incontinence. J Urol 1979; 121: 605- 608.
45. Scott FB, Bradley WE, Timm GW: Treatment of urinary incontinence by implantable prosthetic sphincter. Urology 1973; 1: 252-259..
46. Migliari R, Pistolesi D, De Angelis M: Polypropilene sling of the bulbar urethra for postradical prostatectomy incontinence. Eur Urol 2003; 43: 152-157.
47. Schaeffer AJ, Clemens JQ, Ferrari M, et al: The male bulbourethral sling procedure for post-radical prostatectomy incontinence. J Urol 1998; 159: 1510-1515.
48. Madjar S, Jacoby K, Giberty S, et al: Bone anchored sling for the treatment of post-prostatectomy incontinence. J Urol 2001; 165: 72-76.
49. Comiter CV: The male perineal sling: intermediate term results. Neurourol Urodyn. 2005; 24: 648-653.
50. Rajpurkar A, Onur R, Singla A: Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol 2005; 47: 237-242.
51. Onur R, Rajpurkar A, Singla A: New perineal bone-anchored male sling: lessons learned. Urology 2004; 64: 58-61.
52. Sousa-Escandon A, Rodriguez G, Uribarri GC, et al: Externally adjustable sling for treatment of male stres urinary incontinence: points of technique and preliminary results. J Endourol 2004; 18: 113-118.
53. Romano SV, Metrebian SE, Vaz F, et al: An adjustable male sling for treating urinary incontinence after prostatectomy: a phase III multicentre trial. BJU Int. 2006; 97: 533-539.
54. Hubner WA, Schlarp OM: Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapy. BJU Int 2005; 96: 587-594.
55. İnci K, Ergen A, Yüksel S, et al: A new technique in the treatment of post-prostatectomy incontinence: adjustable male sling. [abstract]. AUA annual meeting, 2007, Anaheim, CA.
56. Montague DK, Angermeier KW: Postprostatectomy urinary incontinence: The case for artificial urinary sphincter implantation. Urology 2000; 55: 2-4.
57. Gousse AE, Madjar S, Lambert M, et al: Artificial urinary sphincter for post radical prostatectomy urinary incontinence: long-term subjective results. J Urol 2001; 166: 1755-1758.
58. Clemens JQ, Schuster TG, Konak JW, et al: Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol 2001; 166: 1372- 1375.
59. Gundian JC, Barrett DM, Parulkar BG: Mayo Clinic experience with use of the AMS800 artificial urinary sphincter for urinary incontinence following radical prostatectomy. J Urol 1989; 142:1459-1461
60. Marks JL, Light JK: Management of urinary incontinence after prostatectomy with the artificial urinary sphincter. J Urol 1989; 142: 302-304.
61. Perez LM, Webster GD: Successful outcome of artificial urinary sphincters in men with post-prostatectomy urinary incontinence despite adverse implantation features. J Urol 1992; 148: 1166- 1170.
62. Litwiller SE, Kim KB, Fone PD, et al: Post-prostatectomy urinary incontinence and artificial urinary sphincter: a long term study of patient satisfaction and criteria for success. J Urol 1996; 156: 1975-1980.
63. Rehder P, Gozzi C: Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol 2007; 52: 860-867.
64. Zonnevijlle ED, Perez-Abadia G, Stremel RW, et al: Dynamic graciloplasty for urinary incontinence: the potential for sequential closed lop stimulation (abs). Med Eng Phys 2003; 25: 755-763.
65. Palacio MM, Van Aalst VC, Perez-Abadia GA, et al: Muscular urinary sphincter: electrically stimulated myoplasty for functional sphincter reconstruction. J Urol 1998; 160: 1867-1871.
66. DiMarco DS, Elliott DS: Tandem cuff artificial urinary sphincter as a salvage procedure following failed primary sphincter placement fort he treatment of post-prostatectomy incontinence. J Urol 2003; 170: 1252-1254.
67. Guralnick ML, Miller E, Toh KL, et al: Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol 2002; 167: 2075-2078.
68. Furuta A, Jankowski RJ, Honda M, et al: State of the art of where we are at using stem cells for stress urinary incontinence. Neurourol Urodyn 2007; 19: published online: 19 Jun,.
69. Strasser H, Marksteiner R, Margreiter E, et al: Transurethral ultrasound guided stem cell therapy of urinary incontinence [abstract]. J Urol 2006; 175: 291.
70. Carr LK, Steele D, Steele S, et al: Single institution clinical trial of musclederived cell injection to treat stress urinary incontinence [abstract]. J Urol 2006; 175: 414.
71. Defidio L, Franco N, Baum N: Suburethral sling for male urinary incontinence. Arch Ital Urol Androl 2002; 74:138-141.
72. Fassi-Fehri H, Badet L, Cherass A, et al: Efficacy of the InVance male sling in men with stress urinary incontinence. Eur Urol 2007; 51: 498-503.
73. Fischer MC, Huckabay C, Nitti VW: The male perineal sling: assessment and prediction of outcome. J Urol 2007; 177: 1414- 1418.
74. Kabul Tarihi: 26.11.2007