Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study)

Majoros, Attila; Bach, D.; Keszthelyi, Attila; Hamvas, A.; Romics, Imre

doi:10.1002/nau.20190

Cited by 134 publications

(120 citation statements)

References 30 publications

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“…Previous studies have already proved that the functional urethral length is decreased after RRP, and that its postoperative values are significantly different in continent and incontinent patients [5,6] . It has also been proved that preoperative sphincter pressure parameters might partly influence postoperative continence.…”

Section: Discussionmentioning

confidence: 95%

“…Recent publications based on surveys with high case numbers estimate its frequency at between 6 and 20% [1][2][3][4] . Some studies dealing with postprostatectomy incontinence focused on urodynamic factors being responsible for incontinence [5][6][7][8] , whereas others tried to analyze the impact of the pre-and perioperative factors ( table 1 ) on urinary incontinence [2][3][4][9][10][11][12][13][14][15][16][17] . Some of the authors showed no association between the above-mentioned factors and postoperative incontinence [2, 11-13, 15, 17] , while others believed that older age, lack of a nerve-sparing technique, presence of anastomotic stricture, bladder neck resection and creating vesicourethral anastomosis without a long, partially intraprostatic portion of the urethra could be responsible for incontinence or at least represent risk factors delaying continence [1,3,4,9,10,14,16,[18][19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Risk Factors for Urinary Incontinence after Radical Prostatectomy

Majoros

Bach²,

Keszthelyi

et al. 2007

Urol Int

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Introduction: Our aim was to identify the independent risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP). Materials and Methods: Using univariate and multivariate analyses, we examined several pre- and perioperative factors. One hundred and sixty-six patients were divided into three groups: patients who were immediately continent after catheter removal (group I), patients who became continent later (group II) and incontinent patients (group III). Results: There were 34 patients (20.5%) in group I, 111 (66.9%) in group II, and 21 (12.6%) in group III. The multivariate analysis between the continent and incontinent patients proved that the postoperatively measured total length of the posterior urethra (strongly associated with length of the sphincter, length of the urethral stump and the presence of anastomotic stricture) was the independent risk factor for permanent incontinence or delayed continence following RRP. The age of patients per se represented a risk factor only for delayed continence, but not for permanent incontinence. Conclusions: Postoperatively measured shorter posterior urethral length results in an increased risk of urinary incontinence and delays continence after RRP. It seems that older age only delays reaching continence.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Analysis of Risk Factors for Urinary Incontinence after Radical Prostatectomy

Majoros

Bach²,

Keszthelyi

et al. 2007

Urol Int

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“…7,19,22 There were statistically significant decreases of maximum urethral closing pressure, functional profile length, and bladder compliance in the incontinent group as compared with the continent group in both laparoscopic and open surgery. As some studies reported that urethral closure pressure and functional urethral length are indeed the dominant factors that determine continence in the residual sphincter, the degradation of the urethral sphincteric function expressed as a decrease of urethral closing pressure and functional profile length is suggested to be a major factor contributing to the postoperative occurrence of urinary incontinence.…”

Section: Discussionmentioning

confidence: 95%

Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function

et al. 2009

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Objectives:To assess the impact of laparoscopic radical prostatectomy on vesicourethral function and compare it to that of open radical prostatectomy. Methods: Sixty-three patients undergoing laparoscopic radical prostatectomy for localized prostate cancer were included in this retrospective analysis. Urodynamic parameters, including maximum urethral closing pressure (MUCP), functional profile length (FPL), bladder compliance, maximum cystometric capacity (MCC) and detrusor overactivity, were considered. Continence status and changes in urodynamic findings before and after surgery were evaluated. In addition, postoperative urodynamic findings were compared with those in 58 patients undergoing open radical prostatectomy. Results: After laparoscopic radical prostatectomy, MUCP and FPL showed a significant postoperative decrease. Continence rates after surgery were 82% in the laparoscopic and 78% in the open group. Comparison of postoperative data between continent and incontinent patients in both surgical groups showed significantly lower MUCP, shorter FPL, lower bladder compliance and higher incidence of detrusor overactivity in incontinent patients. Although there was no significant difference in postoperative MUCP and FPL between the two groups, bladder compliance was significantly lower and incidence of detrusor overactivity was significantly higher in the open prostatectomy group. Conclusions: Laparoscopic radical prostatectomy has a negative impact on storage function by impairing function of the urethral sphincter and decreasing bladder compliance. There is no difference in postoperative urethral function between open and laparoscopic radical prostatectomy. Laparoscopic surgery might be associated with less impairment of bladder function than open surgery.

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“…These results were predictors of stress UI after prostatectomy, suggesting that for incontinent patients, immediate intervention is more appropriate than watchful waiting. Majoros et al [15] have demonstrated that those patients who were immediately continent following the removal of the bladder catheter had had a higher preoperative MCUP. Along the same line, Dubbelman et al [16] found the UPP to be a good preoperative predictor of UI when instructing patients about pelvic floor muscle exercises.…”

Section: Discussionmentioning

confidence: 99%

Prospective Urodynamic Model for Prediction of Urinary Incontinence after Robot-Assisted Radical Prostatectomy

Barnoiu¹,

Galisteo²,

Lopez

et al. 2013

Urol Int

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Objectives: To assess the preoperative urodynamic predictors of urinary incontinence (UI) 1 year after robot-assisted radical prostatectomy (RARP) and to design a nomogram capable of predicting its occurrence. Materials and Methods: Our prospective study included 58 previously continent patients who underwent RARP, in most cases, bilateral nerve-sparing and bladder neck preservation. A urodynamic examination including a urethral pressure profile was performed preoperatively. Multivariate analysis was used to assess the predictors for the need to use 1 or more pads/day and a nomogram was constructed. Results: There was a 20.6% incidence of UI at 1 year after RARP. Bladder compliance, maximum urethral closure pressure and the development of bladder outlet obstruction, correlated well with the incidence of UI on the multivariate analysis (p = 0.043, 0.001, and 0.05, respectively). Conclusion: Bladder compliance <27.8 ml/cm H₂O, maximum urethral closure pressure <50.3 cm H₂O and the bladder outlet obstruction are independent urodynamic factors correlating with UI after RARP. The new nomogram can objectively predict a patient likelihood of requiring 1 or more pads/day 1 year after RARP with a good accuracy.

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Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study)

Cited by 134 publications

References 30 publications

Analysis of Risk Factors for Urinary Incontinence after Radical Prostatectomy

Analysis of Risk Factors for Urinary Incontinence after Radical Prostatectomy

Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function

Prospective Urodynamic Model for Prediction of Urinary Incontinence after Robot-Assisted Radical Prostatectomy

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