Men's experiences of regaining urinary continence following robotic-assisted laparoscopic prostatectomy (RALP) for localised prostate cancer: a qualitative phenomenological study

AIMS AND OBJECTIVES: To understand how men interpret their experiences of regaining continence following robotic-assisted laparoscopic prostatectomy (RALP).

BACKGROUND: RALP is an innovative surgical technique intended to minimise the risk of long-term postoperative urinary incontinence in localised prostate cancer. Studies have shown that urinary function and quality of life domains can be adversely affected following RALP; however, the impact on men's lives has been hitherto unreported.

DESIGN: A qualitative study using hermeneutic phenomenology

METHODS: Face-to-face, in-depth audio-recorded interviews with seven men (aged 57-71) who had recently undergone RALP and defined themselves as continent of urine. Data were inductively analysed for themes using an adapted version of Diekelmann et al. [1989, The NLN Criteria of Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, 1st edn. National League for Nursing (NLN) Press, New York, NY] framework.

RESULTS: Men's experiences of regaining continence were situated within a wider network of personal and social relationships, and cultural structures. Themes included 'what was forecast', 'after-sales service', 'new plumbing', 'sense of self'. Men adopted a variety of practical coping strategies: preventing incontinence; improving incontinence; and dealing with lack of bladder control.

CONCLUSION: The need to regain a sense of control over their lives resulted in all men developing coping mechanisms in order that they could resume their societal roles, which were salient to their personal identity, inferring that men's ability to cope with incontinence after RALP was dependent on factors other than urinary leakage alone.

RELEVANCE TO CLINICAL PRACTICE: Knowledge of the potential impact of RALP could help nurses tailor appropriate interventions. Incontinence is individually interpreted and may not be well-addressed by traditional 'one-size fits all' preoperative programmes or information. Flexible and imaginative options (e.g., activity-focused interventions; buddy systems; internet programmes; telephone follow-up) for preoperative and postoperative support and activities for men may improve men's uptake of such services, through specialist nurse or peer support.