Incontinence After Prostate Treatment
Publication Date: June 27, 2024
Last Updated: June 28, 2024
Guideline Statements
Pre-Treatment
Clinicians should inform patients undergoing localized prostate cancer treatment of all known factors that could affect continence. (Moderate, B)
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Clinicians should counsel patients regarding the risk of sexual arousal incontinence and climacturia following localized prostate cancer treatment.
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Clinicians should inform patients undergoing radical prostatectomy that incontinence is expected in the short-term and generally improves to near baseline by 12 months after surgery but may persist and require treatment. (Strong, A)
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Prior to radical prostatectomy, patients may be offered pelvic floor muscle exercises or pelvic floor muscle training. (Conditional, C)
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Clinicians should inform patients undergoing radical prostatectomy or transurethral resection of the prostate after radiation therapy of the high rate of urinary incontinence following these procedures. (Moderate, C)
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Post-Prostate Treatment
In patients who have undergone radical prostatectomy, clinicians should offer pelvic floor muscle exercises or pelvic floor muscle training in the immediate post-operative period. (Moderate, B)
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In patients with bothersome stress urinary incontinence after prostate treatment, surgery may be considered as early as six months if incontinence is not improving despite conservative therapy. (Conditional, C)
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In patients with bothersome stress urinary incontinence after prostate treatment, despite conservative therapy, surgical treatment should be offered at one year post-prostate treatment. (Strong, B)
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Evaluation of Incontinence after Prostate Treatment
Clinicians should evaluate patients with incontinence after prostate treatment with history, physical exam, and appropriate diagnostic modalities to categorize type and severity of incontinence and degree of bother. (Clinical Principle, )
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In patients with urgency urinary incontinence or urgency predominant mixed urinary incontinence, clinicians should offer treatment options per the American Urological Association Overactive Bladder Guideline.
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Prior to surgical intervention for stress urinary incontinence, stress urinary incontinence should be confirmed by history, physical exam, or ancillary testing. (Clinical Principle, )
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Clinicians should inform patients with incontinence after prostate treatment of management options for their incontinence, including surgical and non-surgical options. (Clinical Principle, )
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In patients with incontinence after prostate treatment, physicians should discuss risk, benefits, and expectations of different treatments using the shared decision-making model. (Clinical Principle, )
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Prior to surgical intervention for stress urinary incontinence, cystourethroscopy should be performed to assess for urethral and bladder pathology that may affect outcomes of surgery. (Expert Opinion, )
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Clinicians may perform urodynamic testing in a patient prior to surgical intervention for stress urinary incontinence in cases where it may facilitate diagnosis or counseling.
(Conditional, C)322859
Treatment Options
In patients seeking treatment for incontinence after radical prostatectomy, pelvic floor muscle exercises or pelvic floor muscle training should be offered. (Moderate, B)
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Clinicians should discuss the option of artificial urinary sphincter with patients who are experiencing mild to severe stress urinary incontinence after prostate treatment. (Strong, B)
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Prior to implantation of artificial urinary sphincter, clinicians should ensure that patients have adequate physical and cognitive abilities to operate the device.
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In patients who select artificial urinary sphincter, clinicians should preferentially utilize a single cuff perineal approach. (Moderate, C)
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Clinicians should discuss the option of male slings with patients as treatment options for mild to moderate stress urinary incontinence after prostate treatment. (Moderate, B)
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Clinicians should not routinely implant male slings in patients with severe stress incontinence.
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Clinicians may offer adjustable balloon devices to non-radiated patients with mild to severe stress urinary incontinence after prostate treatment. (Conditional, C)
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Clinicians should manage patients with stress urinary incontinence after treatment of benign prostatic hyperplasia the same as patients that have undergone radical prostatectomy. (Moderate, C)
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In patients with stress urinary incontinence after primary, adjuvant, or salvage radiotherapy who are seeking surgical management, clinicians should offer artificial urinary sphincter over male slings or adjustable balloons. (Moderate, C)
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In patients with incontinence after prostate treatment, clinicians should counsel patients that efficacy is low and cure is rare with urethral bulking agents. (Strong, B)
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Clinicians should consider other potential treatments for incontinence after prostate treatment as investigational, and patients should be counseled accordingly. (Expert Opinion, )
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Complications after Surgery
Clinicians may counsel patients regarding risk factors for artificial urinary sphincter erosion.
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Clinicians should counsel patients that artificial urinary sphincter will likely lose effectiveness over time, and reoperations are common.
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In patients with persistent or recurrent urinary incontinence after artificial urinary sphincter or sling, clinicians should again perform history, physical examination, and/or other investigations to determine the cause of incontinence. (Clinical Principle, )
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In patients with persistent or recurrent stress urinary incontinence after sling, clinicians should recommend an artificial urinary sphincter. (Moderate, C)
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In patients with persistent or recurrent stress urinary incontinence after artificial urinary sphincter, clinicians should discuss artificial urinary sphincter revision with the patient. (Strong, B)
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In patients presenting with infection or erosion of an artificial urinary sphincter or sling, clinicians should perform explantation and reimplantation should be delayed. (Clinical Principle, )
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After explanting an eroded device, clinicians may manage artificial urinary sphincter urethral cuff erosion intraoperatively with urethral catheter alone, in situ urethroplasty, or anastomotic urethroplasty.
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Special Situations
Clinicians should discuss urinary diversion with patients who are unable to obtain long-term quality of life due to incontinence after prostate treatment. (Expert Opinion, )
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In patients with bothersome incontinence during sexual activity, clinicians should offer treatment. (Moderate, C)
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In patients with stress urinary incontinence following urethral reconstructive surgery, clinicians may offer artificial urinary sphincter and counsel that complication rates are higher. (Conditional, C)
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In patients with incontinence after prostate treatment and erectile dysfunction, clinicians may offer a concomitant or staged procedure. (Conditional, C)
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In patients with symptomatic vesicourethral anastomotic stenosis or bladder neck contracture, clinicians should treat the patient prior to surgery for incontinence after prostate treatment.
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Title
Incontinence After Prostate Treatment
Authoring Organizations
American Urological Association
Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction
Publication Month/Year
June 27, 2024
Last Updated Month/Year
July 31, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
In 2023 the American Urological Association (AUA) requested an Update Literature Review (ULR) to incorporate new evidence generated since the 2019 publication of this Guideline. The resulting 2024 Guideline Amendment addresses updated recommendations to provide guidance for the care of patients with incontinence after prostate treatment (IPT).
Inclusion Criteria
Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Medical assistant, nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D011468 - Prostatectomy, D014549 - Urinary Incontinence, D011470 - Prostatic Hyperplasia
Keywords
Urinary Incontinence, Incontinence, prostate treatment
Source Citation
Breyer BN, Kim SK, Kirkby E, Marianes A, Vanni AJ, Westney OL. Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024). J Urol. 2024 Jun 27:101097JU0000000000004088. doi: 10.1097/JU.0000000000004088. Epub ahead of print. PMID: 38934789.
Methodology
Number of Source Documents
257
Literature Search Start Date
December 1, 2000
Literature Search End Date
June 1, 2023