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Guiding Clinical Decision Making for Surgical Incontinence Treatment After Prostatectomy: A Review of the Literature

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Abstract

Purpose of Review

Stress urinary incontinence after prostatectomy is a common and debilitating side effect. Immediate post-prostatectomy management emphasizes pelvic floor muscle exercises. Per American Urologic Association guidelines, if incontinence persists for more than 12 months postoperatively, surgical interventions are the mainstay of treatment. Treatment decisions depend on a multitude of factors. The goal of this paper is to review recent literature updates regarding the diagnosis of male SUI to better guide surgical treatment decision-making.

Recent Findings

Patient history is a critical component in guiding surgical decision making with severity and bother being primary factors driving treatment decisions. Recent studies indicate that a history of pelvic radiation continues to impact the overall duration and complication rate associated with artificial urinary sphincters (AUS). Cystoscopy should be done on every patient preparing to undergo surgical SUI treatment. Urodynamics and standing cough stress tests are additional diagnostic testing options; these tests may augment the diagnosis of SUI and better delineate which patients may benefit from a male sling versus AUS.

Summary

Treatment of SUI after prostatectomy can improve health-related quality of life. A patient history focused on severity and degree of bother in addition to the use of ancillary office testing can help guide surgical treatment decisions to optimize patient continence goals.

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Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA

    Meenakshi Davuluri, Gina DeMeo & Jim C. Hu

  2. College of Osteopathic Medicine, Touro University, New York, NY, USA

    Gina DeMeo

  3. School of Medicine, Tufts University, Boston, MA, USA

    Suhas Penukonda

  4. City University of New York, Brooklyn College, Brooklyn, NY, USA

    Basimah Zahid

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  1. Meenakshi Davuluri
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Correspondence to Meenakshi Davuluri.

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Davuluri, M., DeMeo, G., Penukonda, S. et al. Guiding Clinical Decision Making for Surgical Incontinence Treatment After Prostatectomy: A Review of the Literature. Curr Urol Rep 24, 527–532 (2023). https://doi.org/10.1007/s11934-023-01181-6

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