Urinary incontinence after non-nerve-sparing radical prostatectomy with neoadjuvant androgen deprivation

Objectives. The impact of non-nerve-sparing retropubic radical prostatectom y (RRP) for prostate cancer combined with neoadjuvant androgen deprivation on urinary control is not well documented. We examined the incidence and se verity of urinary incontinence after such therapy and determined the etiolo gic factors causing this complication. Methods. We examined the postoperative continence status of 104 consecutive patients admitted to the National Cancer Center Hospital who underwent RRP with wide resection of the pelvic nerves after neoadjuvant androgen depriv ation. Incontinence was scored according to the number of pads used daily b y the patient for urinary leakage. The severity of incontinence was analyze d according to patient age, weight of resected specimen, status of cancer s tage, duration of neoadjuvant androgen blockade therapy, preoperative lengt h of membranous urethra, and duration of urethral catheterization after sur gery. We also measured the configuration and diameter of the reconstructed bladder neck by retrograde cystourethrography. Results. In 104 patients examined, the percentage of patients who became dr y postoperatively was 22% at 1 month, 47% at 3 months, 69% at 6 months, and 78% at 1 year. Of 81 patients who became dry postoperatively at any interv al, 22 (27%) became continent within 1 month of RRP, 49 (61%) were continen t within 3 months, 71 (88%) became continent by 6 months, and another 10 (1 2%) became continent between 6 and 12 months postoperatively. Of 48 patient s who were followed up for more than I year and for whom continence status at 1 month after surgery was available, all patients who used 1 to 2 pads p er day (13 of 13) at 1 month after surgery regained continence by 1 year af ter surgery. However, only 62% of patients (16 of 26) who required more tha n 3 pads per day at 1 month after surgery became dry by 1 year after surger y. Only age (older than 70 years) and large prostate size (weight of surgic al specimen more than 40 g) temporarily influenced the recovery of urinary continence after surgery. Dilation of the bladder neck evaluated by retrogr ade cystourethrography was prominent in severely incontinent patients in th e immediate postoperative period. Conclusions. Our experience in patients who undergo non-nerve-sparing RRP a fter neoadjuvant androgen deprivation closely matches published surveys of patient-reported complications. Postoperative incontinence is not a major c ontraindication for non-nerve-sparing RRP after neoadjuvant endocrine thera py. Dilation of the bladder neck affected the recovery from incontinence, h ighlighting the importance of adequate reconstruction of the bladder neck. (C) 1999, Elsevier Science Inc. All rights reserved.