Post radical prostatectomy urinary incontinence

1. Post radical prostatectomy
Urinary Incontinence

2. History
• 67 years Gentleman
• Poor flow, frequency 4 years back
• No urgency, hematuria, AUR or incontinence
• Diagnosed to have carcinoma prostate
• Open radical prostatectomy for carcinoma prostate
March 2014

3. • Post operatively - poor flow of urine, straining and
urinary leakage at walking, coughing .
• No leakage at night.
• EIU for anastomotic site stricture – October 2015
• H/O TURP in 1995, Bilateral hernioplasty 2015
• No co-morbidities

5. Examination
• General physical examination was unremarkable.
• Pulse 84/min. BP 120/80 mmHg
• PA: Lower mid line scar and bilateral hernioplasty
scar. Bladder not palpable.
• External genitalia: EUM, testes & cord structures
were normal.
• DRE: Tone normal with positive BCR & prostate not
felt.

7. Investigations
• Hemoglobin: 14.8 gm/dl
• TLC: 6700 / cumm
• Creatinine : 0.9 mg %
• Urine R/M: Normal
• Urine C/S : No growth
• PSA : < 0.04 ng/dl

8. Uroflowmetry
Q max = 10 ml/sec, Voided volume 266 ml, PVR = 90 ml

9. Ultrasound KUB
Kidneys Bladder

10. MCU
Scout RGU

11. MCU
RGU Full Bladder

12. MCU
Micturating Post void

13. • USG report:-
• Bilateral mild hydroureteronephrosis
• MCU report:-
• No strictures or leak

15. Management
• Conservative :
– In view of mild HUN , advised to follow up after 6
months before planning of artificial urinary
sphincter.

17. Learning Points
• Causes
• How to prevent it?
• management