Urinary continence following radical prostatectomy.

An examination was made of pre- and postoperative variables for predicting urinary continence following radical prostatectomy in 94 consecutive patients. Postoperative recovery of urinary continence continued for up to 18 months, when it plateaued. No pads were required in 73.0% of the patients at 18 months. The interval until recovery of urinary continence following surgery averaged 4.0 +/- 3.3 months. Clinical stage, pathologic stage, tumor grade, tumor volume, preservation of neurovascular bundles, methods of bladder neck reconstruction, internal urethrotomy for anastomotic stricture and postoperative adjuvant external beam radiation therapy provided no indication of postoperative urinary incontinence. Preoperative endocrine therapy, preoperative prostate-specific antigen level of > or = 10.0 ng/ml and age < 70 years at the time of surgery were all associated with a greater probability of urinary incontinence. Multiple factors are involved in the etiology of postprostatectomy urinary incontinence. In patients who had undergone surgery because of local progression following endocrine therapy associated with a high serum prostate-specific antigen level, a significantly inferior outcome was noted. Stricter criteria for indicating radical prostatectomy in patients with prostate cancer are needed. Surgical techniques should also be improved for better overall continence.