Managing post-prostatectomy incontinence in patients with comorbidities

In this video, Jaspreet S. Sandhu, MD, discusses how he approaches the management of post-prostatectomy urinary incontinence in patients with comorbidities. He was interviewed at the 2025 Desai Sethi Urology Institute Urology on the Beach meeting. Sandhu is an attending surgeon at Memorial Sloan Kettering Cancer Center in New York, New York.

Transcription:

How do you approach the management of post-prostatectomy urinary incontinence in patients with other comorbidities, such as diabetes or neurologic conditions?

Diabetes is not much of a contraindication for us to do anything, partly because post-prostatectomy generally is stress urinary incontinence, so diabetes can lead to bladder dysfunction and so forth, but a lot of these folks already have bladder dysfunction from having their prostate removed or radiation therapy following their prostate removal. So most of these comorbidities, while they do affect the bladder, don't seem to affect the surgeries for stress urinary incontinence, which is what we do. Now, if you have something like an artificial sphincter, there are some data that it may lead to higher complication rates. We haven't seen that. In our experience, anyway, these patients tend to do almost as well as patients who don't have medical comorbidities. Now, the one thing we do worry about is patients on blood thinners, so we want them to stop that before the surgery, partly because every now and then, if you have a bleed, it'll swell up the scrotum to the point where it's difficult to use a sphincter, and it'll take longer for them to heal. And there's a chance, we haven't seen much of this, but there's a chance that hematoma will get infected. So that's the one group we're more cautious with—patients who are on blood thinners. So patients who need blood thinners, we probably would not offer them this surgery.

This transcript was AI generated and edited by human editors for clarity.