الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 162 |  |  |
| | | from | 162 | | |
Abstract
Post prostatectomy voiding dysfunction specially PPI is one of the most important and devastating complication for both the patient and the surgeon. Regardless of the type of prostatectomy, or the nature of the prostate disease, several risk factors are common to all and they include preexisting detrusor and sphincteric dysfunction, increasing age, and surgical expertise. Evaluation of postprostatectomy voiding dysfunction patients needs a complete history taking, complete physical examination and Pad testing. Also a list of important investigations to reach the possible aetiology and it includes: Urinalysis,BUN, serum creatinine, Uroflowmetry, Urodynamic study, Cystourethro-graphy, and Endoscopy.
However, the recommendations for treatment options are still only given generally without a clear association with stage and severity of incontinence or retention. This limitation can only be overcome in the future if sufficient evidence is provided by future clinical studies. Moreover, there exists no single precise definition for incontinence, therefore a fair comparison of study results is often not possible. For early postprostatectomy incontinence, noninvasive therapies like PFMT, biofeedback, and electrical stimulation are, in general, strongly recommended, although there is no strong data to support these recommendations. In addition, there is no conclusive data concerning the optimal timing to begin treatment—specifically for preoperative versus postoperative—noninvasive therapy.
Regarding the pharmacological treatment as a part of non-invasive therapy: The efficacy of duloxetine in men has also been evaluated. Despite the efficacy shown, duloxetine has not yet received approval for treatment of male stress incontinence. Nevertheless, duloxetine is commonly used off-label to treat male stress incontinence.
If noninvasive therapy fails, surgical therapy options are recommended, but the natural healing rate should be taken into account. Only in severe incontinence should surgical therapy be considered before 6 mo to 12 mo after radical prostatectomy. For severe or persistent incontinence the artificial urinary sphincter is still the gold standard of treatment. The AS-800 is associated with high continence and high patient satisfaction rates. It is currently the reference treatment for refractory sphincter incompetence in men.
In recent years, numerous minimally invasive treatment options with different success rates have been investigated. But new surgical techniques must at least match the results of the artificial sphincter. Nevertheless, the patient demand for minimally invasive treatment options is high, and often, poorer results are accepted by the patients in order to avoid an artificial sphincter. Injection therapy has been used sucessfully using various types of injectable materials (eg, collagen, teflon, silicone, autologous fat, autologous chondrocytes, dextranomer/ hyaluronic acid copolymer). Recent studies concerning the use of stem cell therapy as a subtype of injection therapy.
Slings can be recommended for patients with persistent mild or moderate incontinence. With various types of slings used as InVance system, REEMEX system, ProAct system and AdVance retropubic system. For patients with severe incontinence the artificial sphincter is recommended, this technique is expensive and requires invasive surgery and experienced surgeons. It has a high rate of infection and a high rate of urethral atrophy due to the sustained high occlusion pressures on the urethra. In addition, the patient must have the mental and physiologic ability to handle the sphincter. The success rate of the AUS is still the best compared with all the other available surgical treatment options for postprotstatectomy incontinence. Even
.