Adjunctive measures and new therapies to optimize early return of urinary continence

In the era of robotically assisted laparoscopic prostatectomy despite the powerful visualization, refined surgical techniques, minimal blood loss, and multiple nerve-sparing and reconstructive bladder neck techniques, urinary incontinence still creates a significant burden on patients and their treating physicians. Chapter 5 focuses on the preoperative, intraoperative, and postoperative technical and surgical skills and modifications that may improve urinary continence in the early and late postprostatectomy period. In this chapter, we review the literature on nonsurgical interventions that may improve urinary continence in the short near term. Return of urinary continence as reported in the literature varies considerably, depending on surgeon expertise, definition, surgical volume (of both the surgeon and the hospital/medical center), and whether or not the outcome is patient or surgeon reported. Furthermore, the incidence of urinary incontinence experienced by men prior to prostatectomy is generally not recorded and not well known. For instance, Johnson and Ouslander reported 15–30?% of men over age 65 had urinary incontinence to some degree before undergoing radical prostatectomy. Gibbs CF, Johnson 2nd TM, Ouslander JG. Office management of geriatric urinary incontinence. Am J Med. 2007;120:211.