Prediction of Postradical Prostatectomy Urinary Incontinence Through the Combination of the Urethral Pressure Profile With Electromyography of the Urethral Sphincter

Abstract

Purpose: We tested the hypothesis that the urethral pressure profile, in combination with electromyography of the urethral sphincter, may be useful as a predictor of urinary incontinence after radical prostatectomy (RP). The aim of this study was to assess whether the combination of these tests resulted in an improved tool for the prediction of post-RP urinary incontinence.Methods: Patients with indications for RP were included. The urethral pressure profile, including prostatic and sphincter components for maximum urethral closure pressure (MUCP) and functional urethral length, was recorded in combination with needle electromyography of the urethral sphincter. The mean and maximum amplitude of waves were measured twice: 1 month before RP and 6 months after the procedure. The 1-hour pad test was conducted in parallel with other tests. Patients completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The relationship of the results of the tests with post-RP urinary incontinence was studied. Age, urodynamic parameters, pathologic stage, and surgical technique were recorded for analysis as potential confounding factors.Results: Nineteen patients were included within the 1-year study period. Their mean age was 63 years. According to the 1-hour pad test and ICIQ-SF, 42.1% of the sample had urinary incontinence after RP. Prostate MUCP with the mean and during-stress amplitude of waves predicted post-RP urinary incontinence with a sensitivity of 87.5% (P=0.002) in our model. Age, urodynamic parameters, pathological stage, and surgical technique were not related to incontinence after surgery.Conclusions: The combination of the urethral pressure profile (prostatic MUCP) and electromyography of the urethral sphincter might be a useful prognostic predictor of post-RP urinary incontinence.

Modification of bladder thermodynamics in stress urinary incontinence patients submitted to trans-obturator tape: A retrospective study based on urodynamic assessment

“…It is worth noting that, in addition to the elevated urethral resistance, an unrelaxed perineal muscle could also result in results similar to ours. Considering that one publication demonstrates a technique of urodynamic investigation with simultaneous perineal electromyography (Talavera et al, 2022), studies investigating pressure/volume profiles using electromyograms would clarify the potential involvement of perineal relaxation in the TOT-associated impact on urodynamic variables.…”

Urethral pressure profile before radical prostatectomy as a predictor of early postoperative continence

“…It is one of the several measurements utilized as part of full urodynamic diagnosis and commonly used as a quantitative measure of urethral function. In studies of PPI, as well as UI in general, regarding urethral sphincter evaluation, UPP is a predominantly used diagnostic procedure despite some argued limitations in reproducibility 14–18 . UPP was used in this study to assess the urethral sphincter complex function, maximum difference between the urethral and intravesical pressure (maximal urethral closure pressure [MUCP]) and length of the urethra along which the urethral pressure exceeds the intravesical pressure (functional urethral length [FUL]).…”

“…In studies of PPI, as well as UI in general, regarding urethral sphincter evaluation, UPP is a predominantly used diagnostic procedure despite some argued limitations in reproducibility. [14][15][16][17][18] UPP was used in this study to assess the urethral sphincter complex function, maximum difference between the urethral and intravesical pressure (maximal urethral closure pressure [MUCP]) and length of the urethra along which the urethral pressure exceeds the intravesical pressure (functional urethral length [FUL]). The severity of UI and the impact on QoL were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and number of pads used per day.…”