The assessment and management of post-prostatectomy stress urinary incontinence

Urinary incontinence remains one of the most significant complications of radical prostatectomy, known as post-prostatectomy incontinence (PPI), can have profound effects on quality of life. The correct diagnosis is critical, and the urodynamic cause of incontinence established as either stress urinary incontinence or detrusor overactivity. Patient evaluation should also include the use of quality of life questionnaires to assess severity of symptoms and a quantitative pad weight or pad usage assessment. Treatment regimes should incorporate conservative measures pelvic floor exercises, and then failing this, a discussion of the more invasive therapies, including bulking injections, the artificial urinary sphincter or the male suburethral sling. All of these options should be discussed carefully with the patient, including success rates of outcomes and potential adverse effects of treatment.