title: Early endoscopic detection and subsequent removal of sphincter penetrating anastomotic sutures may prevent irreversible urinary incontinence after radical prostatectomy.
abstract: OBJECTIVE
  Iatrogenic sphincter lesions are possible reasons for sphincteric incompetence and postprostatectomy urinary incontinence. The aim of this study was to identify early possible sphincter injuries as causes for urinary incontinence after radical prostatectomy by endoscopic evaluation of the anastomotic region.
  
  
  METHODS
  Among 374 patients who had undergone radical prostatectomy from 2005 to 2009 at our institution, we investigated patients with early postoperative urinary incontinence. Nineteen incontinent patients were identified with the symptomatic triad of early incontinence, reduced urinary flow, and post-void residual (PVR) volume after catheter removal. Patients were examined endoscopically, and the clinical effect of early suture removal in patients with sphincter penetration was evaluated.
  
  
  RESULTS
  Urethrocystoscopic evaluation revealed an isolated sphincter penetration as reason for early postoperative incontinence in 15/19 cases. The suture penetration was observed predominantly in the 3-degree (7/19) and 9-degree (8/19) positions and less frequently in the 12-degree (2/19) and 6-degree (2/19) positions. Four of (21%) 19 patients did show an additional sphincter transection. The penetrating sutures of the urethrovesical anastomosis were removed during the endoscopic procedure, and initial urinary incontinence could be corrected in all cases of isolated sphincter penetration.
  
  
  CONCLUSIONS
  Early severe urinary incontinence, reduced urinary flow, and PVR volume after radical prostatectomy may indicate sphincter penetration by anastomosis sutures. In our patients, early transurethral punctual removal of the penetrating sutures could decrease the early postoperative incontinence rate.
authors.affiliation: Department of Urology, Lukas Hospital, Neuss, Germany. holger.gerullis@gmx.net
authors.forename: Holger
authors.initials: H
authors.lastname: Gerullis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Georgas
authors.forename: Sonja
authors.initials: S
authors.lastname: Quast
authors.forename: Christoph
authors.initials: C
authors.lastname: Eimer
authors.forename: Melanie
authors.initials: M
authors.lastname: Homburger
authors.forename: Daria
authors.initials: D
authors.lastname: Orzechowski
authors.forename: Melek
authors.initials: M
authors.lastname: Altindag
authors.forename: Herbert
authors.initials: H
authors.lastname: Rübben
authors.forename: Thomas
authors.initials: T
authors.lastname: Otto
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000473:pathology* / Q000601:surgery*; D000714:Anastomosis, Surgical; D002404:Catheterization; D042241:Early Diagnosis; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects*; D013537:Sutures; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*