Post-Prostatectomy Urinary Incontinence

Post-prostatectomy urinary incontinence (PPUI) represents the most bothersome long-term complication of prostatectomy. While the risk of PPUI due to invasive treatments of benign prostatic hyperplasia appears to be low (about 1%), the risk is significantly higher after radical prostatectomy (10–50%). Although both external urethral sphincter deficiency and bladder dysfunctions have been considered responsible for PPUI, sphincter deficiency is the most important determinant. Fortunately, PPUI can be effectively cured by specialized management. The first-line treatment based on pelvic floor muscle training has been shown to accelerate continence recovery. Duloxetine is the only available medical treatment demonstrating clinical efficacy for mild-to-moderate PPUI. However, side effects commonly lead to 15–31% of withdrawal. As a result, in the case of refractory PPUI, more invasive options are recommended including artificial urinary sphincters and male slings. Level 1 evidence has been achieved on the efficacy of these surgical treatments that need to be indicated based on an accurate preoperative workout and shared decision-making