Incontinence after Surgery for Benign Prostatic Hypertrophy: The Case for Complex Approach and Treatment

Objective: Whether incontinence after surgery for benign prostatic hypertrophy (BPH) requires simple workup and treatment or being a more complex condition and multifactorial in etiology requiring combined surgical techniques should be investigated in more detail. Methods: We retrospectively reviewed the records of 56 patients referred to us for post-prostatectomy incontinence after surgery for BPH. All patients were subjected to urodynamics. Twenty-three (41.1%) patients required additional ascending urethrogram and/or cystourethroscopy, according to their associated symptomatology and the urodynamic findings, for a definitive diagnosis to be established. Results: Twenty-four patients (42.8%) were found to have complex incontinence (either mixed or any type associated with bladder outlet stenosis), requiring combined treatment. Twenty-three (41.1%) had a simple type of incontinence, i.e., pure sphincter incompetence or unstable detrusor. Three patients had residual adenoma and 1 urethral stricture, while 5 patients (8.9%) remained unclassified. Thirty-seven patients were subjected to treatment, 27 (73%) of them to single-modality treatment (artificial urinary sphincter insertion, oxybutynin chloride, transurethral prostatectomy, optical urethrotomy) and the other 10 (27%) to combined treatment (artificial urinary sphincter insertion plus urethroplasty, ileocystoplasty, permanent urethral stent implantation etc.). The overall socially acceptable continence rate (cured plus significantly improved) of the patients subjected to artificial urinary sphincter insertion reached 85%, being better (90%) for the uncomplicated sphincter incompetence group. Conclusions: Incontinence after surgery for BPH represents a condition that requires careful evaluation. In a significant proportion of patients, a combination of prosthetic and reconstructive techniques is needed for an optimal result to be achieved.