August 31, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume I, Spring 1988

SUCCESS WITH PRESERVATION OF URINARY CONTROL

The most disabling and feared complication following radical prostatectomy is total urinary incontinence (lack of urinary control). Fortunately, it is infrequent. To prevent this complication, there are several important steps in the surgical procedure: the bladder neck must be reconstructed following surgery, the external sphincter must not be damaged during the excision of the tumor, and the bladder neck must be reconnected to the urethra and pelvic floor sphincter with care. If the tumor is located down near the sphincter, it may be necessary to excise muscular tissue in this area to remove all tumor. This is one cause of postoperative urinary incontinence. The other most common cause is variability in the normal anatomy resulting in a short urethral stump. This may create difficulty in placing adequate sutures in the urethra down at the pelvic floor.

In addition to these surgical considerations, it recently has been suggested that the pelvic nerves which control erection also are important for preservation of urinary control postoperatively. Several authors have suggested that the operation which was developed here also improves urinary control following surgery due to preservation of the nerves which control the external sphincter.

Of 320 patients who have been followed one year or longer, 296 (93 percent) are completely dry and wear no pads. There are 21 patients (7 percent) who have stress incontinence for which they wear a pad. No patient is completely incontinent and so far only one patient has undergone placement of an artificial sphincter. As I mentioned, recently several other authors have noted a marked reduction in the frequency of total incontinence in their series once they've adopted this surgical technique.

 

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