Post-Prostatectomy Incontinence: Urodynamic Findings and Treatment Outcomes

Leach, Gary E.; Trockman, Brett A.; Wong, Alan; Hamilton, Jacqueline; Haab, F.; Zimmern, Philippe E.

doi:10.1016/s0022-5347(01)66235-9

Cited by 153 publications

(66 citation statements)

References 16 publications

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“…Bladder dysfunction is recognized in 6.7-92% of the patients [9,[19][20][21] . On the other hand, the sphincteric dysfunction as an only cause of post-prostatectomy incontinence was shown in 22-57% of the patients [22][23][24][25] . Functional urethral length is the length of the posterior urethra which extends from the bladder neck to the corpus spongiosum including external and internal sphincters and has high resting pressure contributing to continence [9] .…”

Section: Discussionmentioning

confidence: 99%

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

Kordan

Alkibay²,

Sözen³

et al. 2007

Urol Int

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Objectives: To determine the anatomical changes in urethral and periurethral tissues after radical retropubic prostatectomy (RRP) by magnetic resonance imaging (MRI) and correlate these changes to continence. Materials and Methods: 14 patients with grade 2–5 incontinence and 16 continent (grade 1) patients who had undergone non-nerve-sparing RRP for clinically localized prostatic carcinoma were evaluated. The sphincteric urethral length, transverse and craniocaudal diameters of both levator ani muscles and the volume of periurethral fibrosis were determined by abdominopelvic MRI. Continent (group 1) and incontinent (group 2) groups were compared in terms of sphincteric urethral length, transverse and craniocaudal diameters of levator ani muscles, volume of periurethral fibrosis, prostate volume, age and pathological stage. Results: Among all the evaluated parameters, a statistically significant correlation was found only between the volume of periurethral fibrosis and the number of postoperative operations for urethral strictures in the incontinent group (p = 0.013, r = 0.859). Conclusions: Our results suggest that the postoperative sphincteric urethral length is not the sole factor in regaining continence after RRP as mentioned in the literature.

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Section: Discussionmentioning

confidence: 99%

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

Kordan

Alkibay²,

Sözen³

et al. 2007

Urol Int

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“…As the number of radical prostatectomies increases mainly due to the early detection of localized cancer using PSA, the number of postoperative incontinent patients is expected to increase, even with the best operative technique. If bladder hyperactivity is sometimes associated, the mechanism of this incontinence is mainly intrinsic sphincter insufficiency [8]. Behavioral training and pelvic exercises may be useful in correcting this condition [9,10], but long-lasting stress incontinence often requires surgical treatment involving either periurethral collagen injection (table 4) or implantation of an artificial urinary sphincter (table 5).…”

Section: Discussionmentioning

confidence: 99%

“…It also depends on the definition of incontinence used, with few authors having addressed the criteria of the International Continence Society [7]. Two mechanisms may be involved in this postoperative complication: sphincteric insufficiency and high-pressure bladder dysfunction, the latter mechanism being reportedly present in 56% of the patients [8]. It must be noted that this needs to be treated by specific means, whether it be by anticholinergics, electric stimulation, or pelvic floor exercises.…”

Section: Introductionmentioning

confidence: 99%

Artificial Urinary Sphincter AMS 800 for Urinary Incontinence after Radical Prostatectomy: The French Experience

Mottet¹,

Boyer

Chartier‐Kastler

et al. 1998

Urol Int

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Post-radical prostatectomy urinary incontinence (PRP-UI) has a major negative impact on the patient’s quality of life with the incidence accounting for over 30% on a patient questionnaire basis. In 1995 the French Urological Association started a prospective survey to investigate the efficacy and safety of the AMS 800 artificial urinary sphincter (AUS) in PRP-UI, and preliminary results are presented for the 103 men enrolled in the study in whom bulbar urethral cuff placement was used exclusively. Surgical revision was necessary in 22 patients (21%). Infection and erosion accounted for 12 non-mechanical revisions leading to complete removal of 6 AUS and to eventual replacement of 6 devices with new ones. Mechanical malfunction accounted for revision in 10 patients (9.7%). Fifty-nine patients (61.45%) reported no leakage for the 96 working devices. Twenty-seven patients (28%) wore no pads, 3 patients used 1 pad and 4 patients used 2 pads/day, and all these patients reported improvement, with only 3 patients (3%) having had more than 2 pads/day. Currently, no non-prosthetic procedure reliably affords such good objective results. Insertion of the AMS 800 AUS no doubt represents an attractive treatment modality available for male urinary incontinence following radical prostatectomy.

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“…Although bladder dysfunction (BD) and sphincteric incontinence (SI) can contribute to UI, 6 SI has been considered to be the primary mechanism related to stress-induced incontinence following RP 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Lack of association between the ICIQ-SF questionnaire and the urodynamic diagnosis in men with post radical prostatectomy incontinence

Reis¹,

Cologna²,

Machado

et al. 2013

Acta Cir. Bras.

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PURPOSE:To analyze the correlation between the "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-UISF) survey and the urodynamic findings in men with urinary incontinence (UI) following radical prostatectomy (RP). METHODS:88 men who presented post-RP UI for a minimum of 1 year were enrolled prospectively. All answered the ICIQ-UISF survey and underwent urodynamic testing. Patients were divided in 3 Groups according to their urodynamic diagnosis: Group 1, patients with sphincteric incontinence (SI) alone; Group 2, patients with mixed UI (SI + Bladder Dysfunction (BD)); and Group 3, patients with BD alone. Data were analyzed using SPSS v16.0 software. RESULTS:There were 51 men in Group 1 (57.9%); 30 in Group 2 (34%); and 7 (7.9%) in Group 3. BD was found in 37/88 patients (42%), but it was the main cause of UI in only 14 patients (15.9%). There was no statistically significant difference among the mean ICIQ-UISFs values from groups 1, 2, or 3 (p>0.05). The symptoms of stress incontinence correlated with the urodynamic finding of SI (r = 0.59), and complaints of urinary urgency correlated with the presence of detrusor overactivity (DO) (r = 0.37), but these complaints did not predict the main cause of UI. CONCLUSION:The etiology of UI following RP cannot be predicted by the ICIQ-UISF survey. Symptoms of stress and urge incontinence predict the findings of SI and DO on urodynamic tests, but they cannot ascertain the main cause of UI. Short Form" (ICIQ-UISF) e os achados urodinâmicos em homens com incontinência urinária (IU) após a prostatectomia radical (PR). RESULTADOS: Dos 88 pacientes avaliados, após a avaliação urodinâmica, 51 homens (57,9%) apresentaram IE isolada (Grupo 1); 30 homens (34%) apresentaram IE associada a DV (Grupo 2) e 7 homens (7,9%) tinham somente DV (Grupo 3). A DV foi encontrada em 37/88 pacientes (42%), mas foi a principal causa de IU em apenas 14 pacientes (15,9%). Não houve diferença estatisticamente significativa entre os valores das médias do "ICIQ-UISFs" entre os grupos 1, 2 ou 3 (p> 0,05). Os sintomas de incontinência de esforço se correlacionaram com o diagnóstico urodinâmico de IE (r = 0,59), e as queixas de urgência miccional se correlacionaram com a presença de hiperactividade do detrusor na avaliação urodinâmica (r = 0,37), entretanto apesar da correlação encontrada, os sintomas não foram capazes de identificar a principal causa da UI . MÉTODOS CONCLUSÃO:A etiologia da UI após a PR não pode ser previsto pelo escore de sintomas obtidos através do "ICIQ-UISF". Os sintomas de perda urinária as manobras de estresse e de urgência miccional estão relacionados a presença de IE e hiperatividade detrusora na avaliação urodinâmica, entretanto estes sintomas não conseguem identificar com segurança qual é o principal fator da IU após a PR.O teste urodinâmico continua sendo o padrão ouro para avaliar a etiologia da IU após a PR.

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Post-Prostatectomy Incontinence: Urodynamic Findings and Treatment Outcomes

Abstract: In our large series most men with prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define cause of incontinence but to direct effective therapy.

Cited by 153 publications

References 16 publications

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

Artificial Urinary Sphincter AMS 800 for Urinary Incontinence after Radical Prostatectomy: The French Experience

Lack of association between the ICIQ-SF questionnaire and the urodynamic diagnosis in men with post radical prostatectomy incontinence

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