Urodynamic Testing in Evaluation of Postradical Prostatectomy Incontinence Before Artificial Urinary Sphincter Implantation

Lai, H. Henry; Hsu, Elias I.; Boone, Timothy B.

doi:10.1016/j.urology.2008.10.037

Cited by 57 publications

(36 citation statements)

References 18 publications

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“…The incidence of low bladder contractility index (<100) was 64.8%. 18 The prevalence of BOO and DO in our patient population is also consistent with previously reported series. In men with post-RP incontinence, the published prevalence of DO is 13% to 61%.…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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

Chung

Dillon

Kurta

et al. 2012

CUAJ

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“…Urodynamic tests which provide for performing differential diagnosis of bladder dysfunction and sphincteric insufficiency are helpful for determining the type of incontinence (18). Urine leakage and the pressure of the leak point should be determined with valsalva during the test.…”

Section: Prevelance and Diagnosismentioning

confidence: 99%

Post Prostatectomy Incontinence

Bozkurt¹,

Akın²,

Nuhoğlu³

2012

JAREM

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Urinary incontinence after prostatectomy for malignant and/or benign prostatic diseases is one of the most serious complications. Urinary incontinence occurs rarely after prostatectomy for benign diseases. However, it may occur more commonly after radical prostatectomy. These complications affect the patient's quality of life. Treatment of incontinence due prostatectomy includes several methods which differ from conservative to invasive surgical procedures. Slings and artificial urethral sphincters (AUS) are used more often than other procedures. Infection ratios and erosion of urethra are less frequent in AUS than in slings. Although AUS is the standard surgical procedure for severe urinary incontinence, slings may be used for severe male incontinence after prostatectomy due to the current development in sling materials.. Herein, we evaluate post prostatectomy urinary incontinence and treatments in the light of a review of current literature. (JAREM 2012; 2: 96-100) Key Words: Male sling, radical prostatectomy, stress urinary incontinence, TURP ÖZETBenign ya da malign hastalıklar için yapılan prostatektomi sonrasında inkontinans gelişmesi en korkulan komplikasyonlardandır. Benign nedenlerle prostatektomi uygulanan hastalarda post operatif üriner inkontinans nadir iken, radikal prostatektomi sonrasında daha yüksek oranlarda görülür. Bu komplikasyon, hastanın yaşam kalitesini önemli derecede etkilemektedir. Prostatektomi sonrası oluşan idrar kaçırma tedavisinde; konservatif yön-temlerden, invaziv girişimlere kadar değişen farklı yöntemler kullanılır. Sling ve artifisyel üriner sfinkter (AÜS) operasyonları bu amaçla en sık kullanılan cerrahi tedavi yöntemlerdir. Sling yöntemleri, AÜS'e göre operasyon sonrası enfeksiyon ve üretral erozyon gibi komplikasyonları açısından düşük risk taşımaktadır. Şiddetli inkontinansta AÜS, günümüzde standart tedavi seçeneği sayılsa da, erkek sling materyallerindeki gelişmeler, ciddi inkontinans vakalarında da sling yöntemlerinin öne çıkacağını göstermektedir. Bu çalışmada prostatektomi sonrası idrar kaçırma ve tedavi yöntemleri güncel bilgiler eşliğinde değerlendirildi. (JAREM 2012; 2: 96-100) Anahtar Sözcükler: Male sling, stres üriner inkontinans, radikal prostatektomi, TURP

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“…The cuff should be deactivated for 6 weeks after surgery to allow healing and reduce erosion risk. Moreover, adverse preoperative factors on urodynamic evaluation prior to AUS implantation (e.g., low bladder capacity, decreased maximum fl ow rate) have not convincingly been shown to adversely impact continence outcomes [ 239 ] .…”

Section: Arti Fi Cial Urinary Sphinctermentioning

confidence: 99%

“…Men over the age of 75 years may also bene fi t from AUS placement, although might need deactivation due to other health conditions [ 250 ] . Patients with bladder dysfunction (e.g., decreased compliance, detrusor overactivity) appear to bene fi t to similar degrees compared to patients with normal bladder function [ 198,239,245,251,252 ] . Despite evidence suggesting double-cuff placement for severe incontinence may improve urinary control or quality of life outcomes [253][254][255] , longer-term follow-up suggests patients may not experience better outcomes and may be more likely to require surgical revision [ 256 ] .…”

Section: Arti Fi Cial Urinary Sphinctermentioning

confidence: 99%

Urinary Incontinence

Skolarus

2012

Prostate Cancer: A Comprehensive Perspective

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Urodynamic Testing in Evaluation of Postradical Prostatectomy Incontinence Before Artificial Urinary Sphincter Implantation

Cited by 57 publications

References 18 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

Post Prostatectomy Incontinence

Urinary Incontinence

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