Val Ward Caroline Grimes Clinical Nurse Specialist: Rochester

Many types
SUI
Urge incontinence Mixed incontinence Overflow Climacturia

Incidence
Varies
2.5-87% Differences in definition & reporting

Factors
Patient Age Stage of disease Co-morbidities Previous TURP Previous radiation Pre op continence status Surgery Technique Surgeon experience Nerve sparing RRP Bladder neck sparing/reconstruction

RRP v Lap RP
Continence after 3 months
80% RRP 62% LRP

RRP provided better functional results in terms of

recovery of continence & potency

Porpiglia F et al 2012

Why does it happen?

Damaged small nerves alongside

prostate resulting in failure of urinary sphincter Stretching of urinary sphincter as prostate removed Loss of supports Over activity of bladder Obstructions/Stricture Co-mobidities Pelvic floor tone

Post prostatectomy incontinence

Bladder dysfunction

Obstruction

Sphincter dysfunction

Subjective
Self reporting

Objective
Leakage measurement Pad weight

Number of pads used

Physicians 5-10% pad use Patients- 74% report pad use

QOL
Study of post RRP patients
Need to wear pads = greater problem than loss of sexual

function
Fowler Jr FJ, Barry MJ, Lu-Yao G et al 1995

Age of retirement
Child care Sick pay

60 is new 40
Patient expectations of outcome

Before my prostatectomy, I had high energy levels & would describe myself as a motivated person who was actively engaged with life. With the coming of incontinence, I am a different person. Frequently, I feel dogged by depression & Im in the middle of existential agnst that weakens my enthusiasm for life. Instead of taking action & initiating things , I feel more passive. Some of that comes from knowing that when I move about, I will leak more. The sense of not being able to control one of my basic bodily functions makes me very sad. My family & a few close friends know of my situation but everyone else is unaware. Sometimes the pressure to continue to appear normal is tough

Treatment Options: PFE

Behavioural modification
Pelvic floor physio Pre/post prostatectomy Evidence shows effectiveness G Dorey BJN 2013 11 radomised trials McDonald et al 2007 Over 1000 men Early recovery of continence in PFET No difference at 6 months

Medication
Anti Cholinergics for urgency
Duloxetine (SRI)

Surgical Options
Symptoms persist beyond a year
Artificial urinary sphincter Male slings

Injectables

Artificial Sphincter
Gold standard for moderate to severe incontinence
High satisfaction rates 90-96% 88 -91% continent at 3-10 years

Male Sling
62 men at 28 mths 65% pad free, 23% improved Oliveira et al BJU 2009
40 men at mean 3 years 55% cured, 32% same or worse 73% short term perineal pain 12.5% sling removed for infection

Gilberti J Urol 2009

Injectables
322 men, av 4.37 injections
Complete continence 17% Duration 6.3 months
Wesney et al, J Urol 2005

Conservative Management
Pads Sheaths

Briefs/Appliances

Pads
Advantages Easy to use Readily available/easily purchased Variety of sizes & absorbencies Disadvantages Disposal- environment Cost Bulky Hot Skin integrity Limited availability from local continence services Self management

Sheaths
Advantages Easy to use Readily available on FP10 Variety of sizes & styles Material- silicone & latex Self confidence Improved QOL Disadvantages Application problems Large abdomen Retraction Cognitive impairment Skin integrity Physicians view Nurses ability & view

Briefs/Appliances
Advantages Easy to use DIY Readily available on FP10 Variety of sizes & styles Self confidence Improved QOL Disadvantages Large abdomen Retraction Cognitive impairment Expensive 24-70 Nurses ability & knowledge Latex

Choosing your Surgeon

Choosing your Surgeon

Choosing your Surgeon

Choosing your Patient