Do Drugs Work

There is evidence that post-radical prostatectomy (post-RP) incontinence is not just the insufficiency of the external urethral sphincter mechanism. Up to a third of men with post-RP incontinence suffer from bladder dysfunction, namely overactive bladder (OAB). OAB is a complex symptom syndrome with poorly defined pathophysiology. It causes a significant burden to patients, negatively affects the quality of their life and its management might be difficult and challenging. The incidence of post-RP OAB ranges from 15.2 to 37.8%. The aetiology is multifactorial and includes the partial decentralization of the bladder, the detrusor underactivity, the bladder outlet obstruction and the co-existence with stress urinary incontinence (SUI). Post-RP SUI may lead to defunctionalized bladder and activation of urethrovesical reflex which further deteriorate post-RP continence. The diagnostic work-up of men with post-RP OAB should aim to identify potential aetiologic factors and personalize the treatment accordingly. Until now, there is no robust data from literature with regards to post-RP OAB management. It seems that anticholinergics and PDE5 inhibitors are effective in improving OAB parameters.