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Minerva Urologica e Nefrologica 2020 May 20

DOI: 10.23736/S0393-2249.20.03782-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Conservative management of urinary incontinence following robot-assisted radical prostatectomy

Michele MARCHIONI 1, 2, 3 , Giulia PRIMICERI 1, 2, Pietro CASTELLAN 1, 2, Luigi SCHIPS 1, 2, Guglielmo MANTICA 3, 4, Christopher CHAPPLE 5, Rocco PAPALIA 6, Francesco PORPIGLIA 7, Roberto M. SCARPA 6, Francesco ESPERTO 3, 6

1 Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, “G. d'Annunzio” University of Chieti, Chieti, Italy; 2 Department of Urology, ASL Abruzzo 2, Chieti, Italy; 3 EAU-ESRU: European Association of Urology, European Society of Residents in Urology; 4 Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy; 5 Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK; 6 Department of Urology, Campus Biomedico University of Rome, Rome, Italy; 7 Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Turin, Italy


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BACKGROUND: Robotic assisted radical prostatectomy (RARP) is getting more and more popularity becoming the most common radical prostatectomy technique. Unfortunately, a not negligible proportion of patients in whom RARP is performed experience urinary incontinence. We aimed to systematically review the current literature evidence on urinary incontinence conservative treatment after RARP.
METHODS: A systematic literature review search using PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines have been adopted. Population consisted of patients with urinary incontinence after RARP (P), conservative intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of continence and quality of life.
RESULTS: Six studies were included. Four of them investigated the use of pelvic floor muscle training (PFMT). PFMT improved pelvic muscle strength. Continence recovery was faster when guided PFMT was adopted. Moreover, two studies tested the effect of solifenacin on urinary incontinence. One of them, a randomized clinical trial, failed to show shorter time to continence in solifenacin group compared to placebo.
CONCLUSIONS: The use of pads is associated with a detrimental effect on quality of life thus active treatment for UI post-RARP are warranted. PFMT has the main advantage to shorten the time for recovery. The use of solifenacin seems to not offer striking advantages in UI following RARP. Future studies should focus on testing the efficacy of these treatments when used after robotic vs. open radical prostatectomy.


KEY WORDS: Robot assisted radical prostatectomy; Prostate cancer; Incontinence management; Localized prostate cancer

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