title: Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery.
abstract: BACKGROUND
  Incontinence after prostatectomy for benign or malignant disease is a well known and often a feared outcome. Although small degrees of incidental incontinence may go virtually unnoticed, larger degrees of incontinence can have a major impact on a man's quality of life.Conceptually, postprostatectomy incontinence may be caused by sphincter malfunction and/or bladder dysfunction. The majority of men with post-prostatectomy incontinence (60 to 100%) have stress urinary incontinence, which is the complaint of involuntary urinary leakage on effort or exertion, or on sneezing or coughing. This may be due to intrinsic sphincter deficiency and may be treated with surgery for optimal management of incontinence. Detrusor dysfunction is more common after surgery for benign prostatic disease.
  
  
  OBJECTIVE
  To determine the effects of surgical treatment for urinary incontinence related to presumed sphincter deficiency after prostate surgery for either benign LUTS secondary to BPH (transurethral resection of prostate (TURP), photo vaporization of the prostate, laser enucleation of the prostate and open prostatectomy) or radical prostatectomy for prostate cancer (retropubic, perineal, laparoscopic, or robotic).
  
  
  METHODS
  We searched the Cochrane Incontinence Group Specialised Register (searched 28 June 2010), MEDLINE (January 1966 to January 2010), EMBASE (January 1988 to January 2010), LILACS (January 1982 to January 2010) and the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies.
  
  
  METHODS
  Randomised or quasi-randomised trials that include surgical treatments of urinary incontinence after prostate surgery.
  
  
  METHODS
  Two authors independently screened the trials identified, appraised quality of papers and extracted data.
  
  
  RESULTS
  Only one study with 45 participants met the inclusion criteria. Men were divided in two subgroups (minimal or total incontinence) and each group was randomized to artificial urethral sphincter (AUS) implantation or Macroplastique injection. Follow-up ranged from six to 120 months. In the trial as a whole, the men treated with AUS were more likely to be dry (18/20, 82%) than those who had the injectable treatment (11/23, 46%) (OR 5.67, 95% CI 1.28 to 25.10). However, this effect was only statistically significant for the men with more severe ('total') incontinence (OR 8.89, 95% CI 1.40 to 56.57) and the confidence intervals were wide. There were more severe complications in the group undergoing AUS, and the costs were higher.
  
  
  CONCLUSIONS
  The evidence available at present is limited because only one small randomised clinical trial was identified. Although the result is favourable for the implantation of AUS in the group with severe incontinence, this result should be considered with caution due to the small sample size and uncertain methodological quality of the study found.
authors.affiliation: Urology, Universidade Federal de Sao Paulo - UNIFESP, Rua Doutor Nicolau de Sousa Queiros, 629 ap.130B, Sao Paulo, Sao Paulo, Brazil, 04105002.
authors.forename: Laercio A
authors.initials: LA
authors.lastname: Silva
authors.forename: Régis B
authors.initials: RB
authors.lastname: Andriolo
authors.forename: Alvaro N
authors.initials: AN
authors.lastname: Atallah
authors.forename: Edina Mk
authors.initials: EM
authors.lastname: da Silva
mesh_terms: D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D020728:Transurethral Resection of Prostate / Q000009:adverse effects; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects / Q000191:economics
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon