NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

McConnell JD, Barry MJ, Bruskewitz RC. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Rockville (MD): Agency for Health Care Policy and Research (AHCPR); 1994 Feb. (AHCPR Clinical Practice Guidelines, No. 8.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Benign Prostatic Hyperplasia: Diagnosis and Treatment

Benign Prostatic Hyperplasia: Diagnosis and Treatment.

Show details

12 Direct Treatment Outcomes— Urinary Incontinence

Although infrequent, total urinary incontinence is a serious complication of prostate surgery. The risk of incontinence appears to be lower after open prostatectomy than after TURP, although this may be due to reporting bias. The risk of incontinence is lower following TUIP than following TURP.

Urinary incontinence is defined as the involuntary loss of urine. Data were abstracted from a variety of BPH treatment outcome studies to determine risk of stress urinary incontinence, urge urinary incontinence, and total urinary incontinence (complete loss of voluntary control over micturition).

Stress Urinary Incontinence

Stress incontinence refers to the involuntary loss of urine during physical activity such as coughing, sneezing, and lifting. Stress incontinence often follows surgical intervention for BPH and is usually temporary. Most studies reporting the incidence of stress urinary incontinence following treatment do not report exactly at what time point during followup the patient was assessed in regard to this particular symptom.

Urge Urinary Incontinence

Urge incontinence refers to the involuntary loss of urine associated with an uncontrollable urge to void. Urge incontinence may be a symptom of severe bladder obstruction. It is recognized as the most extreme manifestation of the irritative symptom of urgency, which is very common in patients with prostatism.

Although an attempt was made to abstract data on urge urinary incontinence, very few studies report this particular outcome. Consequently, the panel did not perform a formal statistical calculation of the mean risk of urge incontinence following treatment.

Total Urinary Incontinence

The risk of total incontinence, defined as the complete loss of voluntary control over micturition, is of great concern to patients facing a treatment decision for BPH. In an overall ranking of 15 different outcomes, the panel's proxy judges (see chapter 18) ranked total incontinence of urine as the fourth most important outcome influencing a treatment decision.

Treatment Comparisons

Urinary incontinence has not been reported following alpha blocker treatment, finasteride treatment, or placebo treatment. Also, in none of the papers reporting on balloon dilation was a patient found to suffer from stress, urge, or total urinary incontinence following treatment. In the panel's opinion, incontinence is possible following balloon dilation but rare.

Studies reviewed show stress incontinence for 1.9 percent and urge incontinence for 0.5 percent of patients following open prostatectomy. The average for total urinary incontinence was 0.5 percent. Following TUIP, 0.8 percent of patients experienced stress incontinence. Urge urinary incontinence was not reported in any TUIP study, and only one patient was reported to have experienced total urinary incontinence following TUIP. The probability for total incontinence following TUIP is less than 0.1 percent. After TURP, 2.1 percent of patients experienced stress incontinence, 1.9 percent had urge urinary incontinence, and 1.0 percent were reported to have total incontinence.

Comparing the risk of incontinence after open prostatectomy with the risk after TUIP and TURP reveals significant differences (Table 20). The probability of total incontinence following TURP is 1.0 percent (90-percent CI 0.7-1.4 percent). This is significantly higher than the 0.5-percent risk of total incontinence following open prostatectomy. The calculated probability of suffering total incontinence following TUIP is 0.1 percent (90-percent CI 0.02-0.5 percent). This may be an overestimation, since only 1 of 1,200 patients in 7 TUIP studies experienced total urinary incontinence after treatment.

Table 20. Combined analysis: stress and total incontinence.

Table

Table 20. Combined analysis: stress and total incontinence.

PubReader format: click here to try

Views

  • PubReader
  • Print View
  • Cite this Page

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...