Written by admin on 2009-03-30T07:58:59+0000">March 30, 2009 – 7:58 am
Incontinence is probably the most dreaded ramification of radical prostatectomy. But fortunately, when the operation is performed by an experienced surgeon, it’s also among the rarest. In one Johns Hopkins study of 593 consecutive patients, 92 percent had complete urinary control after surgery. The remaining 8 percent had some stress incontinence (urine leakage at certain activities, such as running or playing golf). Of these men, 6 percent wore one or fewer pads a day. Only two men had stress incontinence serious enough to warrant placement of an artificial sphincter (see below), and no man was totally incontinent. In the next Johns Hopkins study, of 600 patients, no patient had stress incontinence severe enough to warrant placement of an artificial sphincter.
Of men over age 70, 86 percent were completely continent after surgery, as were 94 percent of the men who had both neurovascular bundles (clusters of nerves on either side of the prostate) preserved, 92 percent of the men who had one bundle removed, and 81 percent of the men who lost both nerve bundles. Also, there did not seem to be a link between potency and continence; 94 percent of potent men and 90 percent of impotent men remained totally continent.
What determines whether or not a man will remain continent? Most important is whether he has a strong sphincter to begin with. Some men have a poorly developed urinary sphincter—and it’s almost impossible to determine this before the operation, because for men, the bladder neck and prostate are effective means of controlling urine. Also important is the skill of the surgeon in preserving the urinary sphincter and carefully rebuilding the urinary tract. But there are other factors, including the patient’s age and whether both neurovascular bundles were removed. It’s fairly clear, from studies at medical centers where radical prostatectomies are performed on older men, that men over 70 seem to have more problems with urinary control than younger men. It’s not entirely clear whether preserving the nerve bundles improves urinary control: Men who had both nerve bundles removed appear to have a slightiy higher rate of incontinence than men in whom both nerve bundles were preserved. However, it’s possible that the urinary sphincter is sometimes damaged in the process of making a wide excision—cutting the bundles and as much tissue surrounding the prostate as possible.
*114\201\8*
