Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction

Abstract

Purpose: The reported incidence of urinary incontinence (UI) due to bladder dysfunction following surgery of BPH is variable. We described the causes of incontinence in a large group of men that developed this unsual complication and analyzed the influence of age on the prevalence of bladder dysfunction. Materials and Methods:We wvaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH : Transurethral resection of the prostate (81men) and open prostatectomy (44 men). A third group of 21 patients with incontinence following radical prostatectomy was used for comparison. All patients underwent urodynamic analysis. Urethral Sphincter Insufficiency (USI)was defined as involuntary loss of urine induced by Valsalva maneuver in the absence of a detrusor contraction. Bladder dysfunction was defined as detrusor overactivity and/or decreased compliance. Results: Urethral sphincter insufficiency was the most common etiology of urinary incontinence in the three groups of patients. However, bladder dysfunction was observed in 59.3%, 56.8% and 57.1% of patients who underwent transurethral resection, open prostatectomy and radical prostatectomy, respectively. Median patient age was 69 and 75 years for patients with and without bladder dysfunction, respectively. A logistic regression model for the presence of bladder dysfunction showed that age was a statistically significant predictor. Conclusions: Urethral Sphincter insufficiency is the main cause of incontinence following surgery for BPH. Bladder dysfunction may be the isolated cause of incontinence in approximately 25% of patients. The chances of bladder dysfunction rises 5.3% for each year added to patient age. Patients older than 70 years have twice the probablility of post procedural incontinence. INTRODUCTIONBPH is the most common benign neoplasm in men (1) and contemporary data shows that about 10% of these patients will need some form of surgical treatment (2). UI following surgery for BPH is a rare complication. While early incontinence may occur in up to 30-40% of patients, late incontinence occurs in fewer than 1% of cases (3,4).The etiology of post-prostatectomy incontinence can be multifactorial, including USI and/ or Bladder dysfunction (BD) defined as Decreased compliance (DC), or Detrusor Overactivity (DO) (5). USI occurs as a result of injury to the sphincter mechanism and incontinence is usually associated with increase in. BD, which includes detrusor overactivity and/or DC. Moreover, DC is associated with increase in detrusor pressure with storage of urine, which can result in urinary incontinence.However, while UI following RP, is mainly attributed to SI, (5,6) the prevalence of BD among patients with UI following surgery for BPH may NeurologyInternational Braz J Urol

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: Analysis of 100 cases from a high-volume urologic center

“…On average, patients with BPH who are candidates for surgical treatment are older than before. Choi et al (18) compared the characteristics of patients who underwent surgery in 1985 to 1989, in 1995 to 1999 and in 2005 to 2009. The mean ages of the men were 65.4, 65.9 and 69.3 years, respectively.…”

Investigation on lower urinary tract symptoms (LUTS) in elderly patients with prostate cancer (PC) received endocrine therapy

“…No available effective means can differentiate the obstruction of lower urinary tract and dysfunction of bladder detrusor muscle due to aging body (Wang, Lu, & Song, 2009). In the study by Homero et al on the patients with urinary incontinence following surgical treatment for BPH showed a close correlation between patients' age and bladder dysfunction presented as the result that the chance of bladder dysfunction rises 5.3% for each year added to patient age (Bruschini, Simonetti, Antunes, & Srougi, 2011). The studies on urodynamics of bladder in aged rats and guinea pig found that both the residual urine in bladder and spontaneous activity of detrusor were significantly increased (Gomez-Pinilla et al, 2007;Zhao et al, 2010).…”

Older Age and Larger Prostate Volume Are Associated with Stress Urinary Incontinence after Plasmakinetic Enucleation of the Prostate

“…Bruschini et al [26] evaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH. Urethral sphincter insufficiency is the main cause of incontinence following surgery for BPH patients older than 70 years, since sphincter function declines with increasing age [27].…”