**3.1 Urinary incontinence after radical prostatectomy**

Urinary incontinence is the most prominent side effect of radical prostatectomy. Urinary incontinence after treatment for localized prostate cancer is caused by sphincter malfunction. So, several technical modifications of open, laparoscopic and robot-assisted laparoscopic radical prostatectomy have been advocated to improve early and late urinary incontinence.

Pardo *et al.* reported that urinary incontinence rates of patients treated with non-nerve sparing RRP and nerve sparing RRP were 69% and 54%.12 It has recently been demonstrated that reconstruction of the posterior aspects of the rhabdoshincter allows a rapid recovery of continence after retropubic radical prostatectomy and laparoscopic radical prostatectomy.13 But, Joshi *et al.*reported that there was no significant difference in early urinary incontinence between the group for which the posterior aspects of the rhabdoshincter were reconstructed and the group for which they were not reconstructed in cases of RALP.14 They suggested the reason why there was no significant difference was a magnified stereoscopic view and/or the finer, more maneuverable instruments in robot system may allow better preservation of sphincter supporting musculature, hence improving continence, and may obviate the advantages of posterior reinforcing sutures.

Di Pierro *et al.* compared continence rate between groups of patients treated with RRP and RALP, and reported that the continence rate of the RALP group was significantly higher than the RRP group at 3 and 12 months after RALP.15 Wang *et al.* reported that continence was achieved in 82%, 87%, and 91% of men at 3, 6, and 12 months after RALP.16 They also reported that the mean IPSS scores of these patients preoperatively and 3, 6, and 12 months after surgery were 14.1, 5.2, 3.0, and 2.9 and corresponding mean QOL scores were 3.4, 2.1, 1.6, and 1.6.13

#### **3.2 Urinary function after radiation therapy, cryotherapy, and HIFU**

Sanda *et al.*reported that 18% of patients in the brachytherapy group, 11% of those in the radiotherapy group, and 7% of those in the prostatectomy group had moderate or worse distress from overall urinary symptoms at 1 year.17 Pardo *et al.* reported that compared to the brachytherapy group, the prostatectomy group showed a greater deterioration of urinary incontinence but better urinary irrigative-obstructive results.12

Hubosky *et al.* reported that the urinary function was similar for the groups of patients treated with cryoablation and brachytherapy until 18 months, at which time cryoablation patients fared better and this was sustained up to 24 months.10

We reported that the QOL index improved significantly at 6 months after HIFU therapy. Our data on uroflowmetry showed that maximum flow rate and residual urine volume were significantly impaired at 6 months after HIFU. However, the data on maximum flow rate and residual urine volume recovered to baseline at 12, 24 months after HIFU.11
