Editing AUA: Incontinence after Prostate Therapy (2019) (section)

== Pre-treatment Counselling ==

* '''Commonly accepted definition of urinary continence: not requiring a pad or protective device to stay dry (pad-free)'''
* '''<span style="color:#ff0000">Factors associated with increased risk of incontinence after RP (5):</span>'''
*# '''<span style="color:#ff0000">Older age</span>'''
*# '''<span style="color:#ff0000">Larger prostate size</span>'''
*# '''<span style="color:#ff0000">Shorter membranous urethral length</span>'''
*# '''<span style="color:#ff0000">Lack of preservation of bilateral neurovascular bundle at time of RP</span>'''
*#* No surgical maneuvers, other than preservation of bilateral neurovascular bundle, results in improved continence recovery. Men receiving bilateral neurovascular bundle preservation were 26% more likely to be continent at 6 months compared to men who did not
*# '''<span style="color:#ff0000">Prior pelvic radiation</span>'''
*#* '''Radiation is a significant risk factor for IPT in patients undergoing RP or TURP.'''
*#** '''These patients should be informed that they may require an artificial urinary sphincter (AUS).'''
** '''<span style="color:#ff0000">Surgical approach: open RP has similar rates of urinary incontinence as robot-assisted RP</span>'''
** '''<span style="color:#ff0000">BMI may impact IPT in the short-term; however, not considered to impact risk at 1-year after RP</span>'''
* '''<span style="color:#ff0000">Natural history</span>'''
** '''<span style="color:#ff0000">Continence after RP improves with time, and most men achieve continence within 12 months of surgery</span>'''
*** '''Most men undergoing RP are not continent (pad-free) at the time of catheter removal and should be informed that continence is not immediate.'''
*** '''<span style="color:#ff0000">Majority of patients will reach their maximum improvement by 12 months with minimal to no improvement afterwards.</span>'''
**** '''90% of patients will achieve continence at 6 months''' after robotic-assisted laparoscopic prostatectomy and only an additional 4% of patients will gain continence afterwards.
*** '''<span style="color:#ff0000">Conservative management with regular follow-up during the first year after surgery is recommended</span>''' to assess patient progress
**** '''In addition to SUI, patients can also develop sexual arousal incontinence and climacturia following RP'''
* '''<span style="color:#ff0000">Pelvic floor muscle exercises (PFME)/Pelvic floor muscle training (PFMT)</span>'''
** PFME is self-guided whereas PFMT is practitioner guided; both are training programs specific to the pelvic muscles
** '''Thought to support muscle strength and enhance blood flow to the sphincter to promote healing'''
** '''<span style="color:#ff0000">Prior to radical prostatectomy: may reduce the risk of IPT</span>'''
*** '''The benefit of starting pre-operative PMFT is not consistent'''
*** Exercises are easier to learn in the pre-operative period due to post-operative muscle inhibition, sensory changes, urinary incontinence, and surgical pain
** '''<span style="color:#ff0000">Immediate post-operative period: should be offered</span>'''
*** '''<span style="color:#ff0000">Improves time to continence (thus improving QoL) but not overall continence at 12 months</span>'''