Early Continence after Radical Prostatectomy

A prospective evaluation of urinary continence in 60 consecutive patients undergoing radical prostatectomy with incorporation of the fascia posterior to the urethra into the vesicourethral anastomosis is described. With this technique complete continence without the need for pads has been achieved in 88% of the patients, with stress incontinence in 10% and total incontinence in 2%. Continence was achieved within 1 to 16 weeks, with 13% of the patients dry during week 1, 55% dry at 6 weeks and 83% dry at 3 months. The median interval to achieve continence was 5 weeks. Median age of the continent patients was significantly lower than that of incontinent patients (65 versus 69 years). Neither the number of neurovascular bundles resected nor the need to reconstruct the vesical neck affected the rate of continence. While the exact mechanism of continence after radical prostatectomy remains unknown, incorporation of the fascia posterior to the urethra into the vesicourethral anastomosis results in earlier continence and thereby lessens the morbidity of this procedure.