Management of Stress Urinary

Incontinence After Radical Prostatectomy

Chung Cheng Wang, M.D. Ph.D

Department of Urology, En Chu Kong Hospital
 Artificial Sphincter
Continence rates ranging
from 70% to 90% after 5
years and from 60% to
80% after 7 years
Long-term complication,
including erosions,
infections, mechanical
failures, and reoperations
 Patients Characteristics
26 male patients with mean age: 69.3 7.7 years old
Mean BMI: 25.2 3.6
UCLA score: 82.8 75.1
Pad use: 3.7 2.6/day
Qmax: 12.8 8.0mL, Voided volume: 161 126mL
PVR: 18.5 29.7 mL
ALPP: 48.9 34.2 cmH2O, CLPP: 68.6 25.1 cmH2O
 UCLA

1.

(1) 0

(2) 33

(3) 67

(4) 100

2.

(1) 0

(2) 33

(3) 67

(4) 100

3.

(1) 0

(2) 50

(3) 100

4.

(1) 100

(2) 75

(3) 50

(4) 25

(5) 0

5.

(1) 100

(2) 75

(3) 50

(4) 25

(5) 0

 Course and Treatment
12 courses of pelvic floor muscle training
in 3 months
After Pelvic Floor Muscle Training
UCLA: 82.8 75.1 70.2 34, p=0.25
Pad use: 3.7 2.6 2.4 1.5, p=0.02
Satisfactory rate: 40%
 Male Sling:
Midline Perineal Incision
Identify Bulbourethra
Wire Passer
Home-Made Mesh
Retrograde Leak Point Pressure:
60cmH2O
Keep Little Water Dripping
 After Male Sling
12 patients
UCLA: 62.0 40.3 248 177, p<0.001
Pad use: 4.7 2.3 0.5 1.0, p
<0.001
Satisfactory rate: 91.7%
Uroflowmetry: no significantly change
Complication: AUR: 1, skin erosion: 1
 Post-op Care
Remove Foley 2 days later PVR
Encourage standing and lying instead of
sitting
Wound care
Avoid constipation
 Patient number Successful rate
Mild incontinence 10/10 100%
Moderate incontinence 9/10 90%
Severe incontinence 25/32 78%
With radiotherapy 6/10 60%
Without radiotherapy 37/41 90.2%
 Conclusion
Conservative treatment has limited effects for
male urinary incontinence after radical
prostatectomy
Male sling is an effective and safe procedure for
male urinary incontinence due to intrinsic
sphincter deficiency
Thanks for Your Attention