Incontinence after Radical Prostatectomy: Detrusor or Sphincter Causes

Chao, Roberto; Mayo, Michael E.

doi:10.1016/s0022-5347(01)67212-4

Cited by 158 publications

(82 citation statements)

References 17 publications

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“…1 For example, a significant proportion of post-RP patients use abdominal voiding (AV) to empty their bladder. [2][3][4] Abdominal straining during voiding may indicate detrusor underactivity (DU). 3 This is important because DU might affect the efficacy of various surgical treatments for male stress urinary incontinence (UI).…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Abdominal straining during voiding may indicate detrusor underactivity (DU). 3 This is important because DU might affect the efficacy of various surgical treatments for male stress urinary incontinence (UI). 5 The International Continence Society (ICS) defines DU as "contraction of reduced strength and/or duration resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span."…”

Section: Introductionmentioning

confidence: 99%

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Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Chung

Dillon

Kurta

et al. 2012

CUAJ

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Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population. Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation. Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009). Conclusions: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Chung

Dillon

Kurta

et al. 2012

CUAJ

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“…Later, collagen was the better understood and the surgical techniques more sophisticated, the frequency of incontinence has most widely used injection material; recently Aboseif et al [13] reported 47% of patients cured and 19% decreased [1,4,5,6]. Reported incontinence rates after RP range from 1 to 30% [3][4][5][6][7][8][9]. Of 380 patients who showing marked improvement.…”

Section: Resultsmentioning

confidence: 99%

“…However, the most significant complication is post-operative inconattempts to treat incontinence using paraBn injections [20]. PTFE (Polytef ) was first used in a large series about tinence, which aCects up to 30% [5][6][7][8][9]. While low-grade post-operative stress incontinence occurs in nearly 30 years ago [10], but the safety was dubious as the migration of PTFE particles was reported in animal all patients and resolves within 6-12 months [8], high-grade persistent incontinence requires specific studies [21,22].…”

Section: Introductionmentioning

confidence: 99%

The use of polydimethylsiloxane in the treatment of incontinence after radical prostatectomy

Colombo

Augustin

Breinl

et al. 1997

British Journal of Urology

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Objective To report the results of transurethral submu-Results After a mean follow-up of 15.5 months, five patients, who suCered from day and night inconticosal injection therapy of polydimethylsiloxane (PDS) to treat incontinence after radical prostatectomy (RP).nence and required at least five pads per day, were dry after injection therapy. One patient improved Patients and methods Since 1993, about 80 retropubic RPs have been carried out at our institution each significantly but still required two pads during the day, but was continent during the night; three patients year. Severe post-operative incontinence occurred in six patients, with a mean duration of incontinence required a second injection. A mean of 7.5 mL of PDS was used per patient and the side-eCects of therapy after RP of 28 months. The pre-operative evaluation consisted of cysto-urethroscopy and urodynamics.(dysuria and urinary retention) were minimal. Conclusion Because PDS has excellent biocompatibility, Because we have no experience with artificial sphincter implantation, transurethral injection therapy was few side-eCects or complications, transurethral injection therapy using silicone particles is a justifiable used to treat the post-operative incontinence, using PDS (vulcanized silicone rubber particles). This mateprocedure for treating incontinence after RP. Keywords Radical prostatectomy, post-operative inconrial has a mean particle size of 188 mm, providing stability of the material at the injection site. The six tinence, transurethral submucosal injection, polydimethylsiloxane patients with severe post-operative incontinence were treated using injection therapy with PDS. various materials, e.g. PTFE, collagen, fat or silicone

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“…2,3 The reported rate of stress incontinence in males after transurethral resection of prostate is 1-5%, 4 and after radical retropubic prostatectomy is approximately 30%. 5,6 There are no figures available for the incidence of male stress incontinence after spinal cord injury (SCI). More than 80% of SCI are in males and two-thirds of these are in individuals less than 30 years of age.…”

Section: Introductionmentioning

confidence: 99%

The treatment of male stress urinary incontinence with polydimethylsiloxane in compliant bladders following spinal cord injury

Hamid

Arya²,

Khastgir

et al. 2003

Spinal Cord

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Study design: Retrospective analysis. Objectives: To evaluate the safety and efficacy of polydimethylsiloxane (PDS, Macroplastiquet) submucosal injections, in the treatment of male genuine stress urinary incontinence secondary to spinal cord injury (SCI). Setting: London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK. Patients and methods: A retrospective analysis identified 14 patients treated with PDS for stress urinary incontinence secondary to SCI between 1997 and 2001. A single surgeon at a specialist spinal injuries unit managed all patients. A total of 13 patients had suffered a traumatic SCI (T11:n ¼ 2; T12:n ¼ 5; L1:n ¼ 5; L2:n ¼ 1), while one developed stress incontinence after spinal surgery. The mean age was 41 years (range 26-69 years) and the mean duration of injury was 9.6 years (range 1.5-48 years). The preoperative investigations included video cystometrogram (VCMG) confirming the presence of urodynamically proven stress incontinence without evidence of urge incontinence. Complete cure was defined as a cessation of pad usage with no evidence of leakage on VCMG. Incomplete cure with improvement was defined as a 450% reduction in the number of pads used, with incontinence present on VCMG. Results: The follow-up ranged from 12 to 58 months (mean 34.7 months). Five patients (36%) reported complete success, confirmed by VCMG. Three patients (21%) reported improvement with 450% reduction in the use of pads. The procedure failed completely in six patients (43%). No immediate or late complications were noted with the procedure. Conclusions: The use of PDS is a safe and minimally invasive treatment for genuine stress urinary incontinence in males following SCI with a stable compliant bladder. We achieved complete cure in 36% of our patients with confirmation on VCMG. A further 21% reported greater than 50% reduction in usage of pads; however, on VCMG stress incontinence was demonstrated in these patients. We suggest that PDS can be used as the first line of treatment in this difficult group of patients with complex problems.

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Incontinence after Radical Prostatectomy: Detrusor or Sphincter Causes

Abstract: Decreased compliance is an infrequent finding after radical prostatectomy. Detrusor abnormalities in general are rarely the sole cause of incontinence, with sphincter weakness being present in the majority of patients.

Cited by 158 publications

References 17 publications

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

The use of polydimethylsiloxane in the treatment of incontinence after radical prostatectomy

The treatment of male stress urinary incontinence with polydimethylsiloxane in compliant bladders following spinal cord injury

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