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.