Male Stress Urinary Incontinence: Evaluation
Predicting continence recovery after prostatectomy, from Matsushita 2015
Post-Prostatectomy Expectations
Incontinence
- Continence: 90% by 6mo, 94% by 12mo, 95% by 24mo
- Kegels: start 3-4 weeks prior to surgery for best results
- XRT: worsens incontinence rates
- Salvage prostatectomy: 20-70% incontinence rate
Climacturia
- Prevalence: ~30% (range 20-93%), 50% report as bothersome, 33% avoid sexual situations
- SUI: 70% SUI also report climacturia...and 70% climacturia report SUI
- Robotic surgery decreases time to no climacturia
- Risk factors: prior TURP, shorter urethral length
- Management: pre-sex urination, condoms, PFPT
Workup + Evaluation
History
- Symptoms: duration, frequency, severity (PPD, pad type), precipitating factors
- Self-reported hx SUI: 95% PPV, 100% NPV
- Prior prostatectomy: 5% will have persistent SUI 2yrs after surgery
- Prior TURP: SUI 0-8%, up to 70% have reported some urge incontinence
- Medications: a-blockers, diuretics, anticholinergics
- Associated symptoms: assess sexual, erectile, and bowel function
- UUI: 29-48% with SUI also report OAB symptoms
Further Workup
- Exam: assess cognitive function and manual dexterity, inguinal hernias, prior surgical scars, neuro exam
- DRE: check prostate (if present), rectal tone, and pelvic floor dysfunction
- Post-void residual: check to ensure patient does not have overflow incontinence
- Bladder diary: 3-days is adequate, can use for UUI or unclear symptoms
- Pad weight: assess severity, < 200g mild, 200-400g moderate, > 400g severe
- UA/UCx: treat UTI prior to surgery
- Cystoscopy: required preop or intraop, assess for stricture, bladder neck contracture
- Urodynamics: use only if it would affect treatment options, 35% patients will not demonstrate SUI while UDS catheter is in place (bladder neck contracture may be present)
References
- AUA Core Curriculum
- Al-Mousa, R. and H. Hashim. "Evaluation and Management of Men with Urinary Incontinence." Campbell-Walsh Urology 12 (2020).
- Boone, T., J. Stewart, and L. Martinez. "Additional Therapies for Storage and Emptying Failure." Campbell-Walsh Urology 12 (2020).
- Matsushita, Kazuhito, et al. "Preoperative predictive model of recovery of urinary continence after radical prostatectomy." BJU international 116.4 (2015): 577-583.
- Sandhu, Jaspreet S., et al. "Incontinence after prostate treatment: AUA/SUFU Guideline." The Journal of urology 202.2 (2019): 369-378.
- Wieder JA: Pocket Guide to Urology. Sixth Edition. J.Wieder Medical: Oakland, CA, 2021.