“When I'm discussing surgery, or any kind of treatment for prostate cancer, with patients, I always talk about the ‘trifecta,’ “ says Ricardo M. de Oliveira Soares, MD.
In this video, Ricardo M. de Oliveira Soares, MD, discusses how incontinence develops in patients post prostatectomy. Soares is a urologist at Northwestern University Feinberg School of Medicine, Chicago, Illinois.
When I'm discussing surgery, or any kind of treatment for prostate cancer, with patients, I always talk about the “trifecta”—the 3 factors [patients] want. Number 1 is getting all the cancer out, so having an undetectable [prostate-specific antigen level]. Number 2 is to be continent. And when I say "be continent," I mean being pad free, because [there are] articles out there that say patients are continent, but they're wearing a pad a day, which is not really being continent. Number 3 is keeping their erectile function. In general, I would say 90% of my patients really worry about the first 2. That's why I'm always trying to improve my technique and try to prepare patients better and better to minimize side effects from the surgery. In about 80% of the cases of incontinence after surgery, there is a sphincter insufficiency problem. That's because when you lose the prostate, you lose all the smooth muscle in the prostatic urethra and sometimes the bladder neck. Also, the striated muscle of the sphincter, although it is still saved, it gets impacted by the surgery. It is impacted because of 4 factors. Number one is because by cutting at the apex of the prostate, you're going to have a shortened membranous urethra, and that has been shown to be a factor and a predictor of incontinence. Number 2, the direct trauma of the surgery into the sphincter is great...and takes time to heal. The third factor is obviously the innervation. Particularly with more advanced cancer, you need to remove part of the neurovascular bundle; the innervation of the sphincter is also affected. Number 4 is hypoperfusion for the same reason; if you remove blood vessels that are supplying blood to the sphincter, there's going to be a need for collateral blood supply and until that happens, there's going to be a time of recovery.
This transcription was edited for clarity.