Urinary incontinence after robotic-assisted laparoscopic radical prostatectomy

This chapter discusses various aspects of urinary incontinence after radical prostatectomy, with specific regard to robotic-assisted laparoscopic radical prostatectomy. The incidence of urinary incontinence following radical prostatectomy is summarized for the various techniques. The primary mechanism of post-radical prostatectomy urinary incontinence, based on urodynamic evidence, is sphincteric dysfunction. Several perioperative risk factors may contribute to urinary incontinence following radical prostatectomy. Age and nerve sparing have the most robust data to support their role in continence outcomes. The evaluation of post-radical prostatectomy incontinence involves a thorough characterization of the incontinence, anatomic evaluation with cystourethroscopy, and a multichannel urodynamic evaluation. Management of urinary incontinence following radical prostatectomy is aimed primarily at treating sphincteric dysfunction. Among the treatment options available, surgical correction of incontinence with a bulbourethral sling or artificial urinary sphincter, depending on the severity of incontinence, are the most effective.