Post-Prostatectomy Incontinence: Urodynamic Findings and Treatment Outcomes

Purpose

We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence.

Materials and Methods

A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocative multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment.

Results

Based on the results of urodynamic studies 40 percent of the men had genuine stress incontinence alone and approximately 60 percent had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p less than 0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement.

Conclusions

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

The Role of Urodynamics in Post-Prostatectomy Incontinence

Purpose of Review

Radical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer. One of the side effects after RP impacting quality of life is urinary incontinence. Because of the impact in quality of life, more patients are seeking treatment for post-prostatectomy incontinence. Urodynamics are an important tool to help understand how prostate surgery changes bladder and urethral function. We reviewed the current literature in order to determine the role of urodynamics in post-prostatectomy incontinence.

Recent Findings

Studies have been done to demonstrate the anatomical and functional changes in incontinent men after radical prostatectomy compared to continent men, as well as to evaluate the use of urodynamics in the work-up for post-prostatectomy incontinence prior to treatment. However, there is not a consensus about the indications of urodynamics in this population and new studies have questioned the real role of urodynamics in this setting.

Summary

Because of the impact in quality of life, more patients are seeking treatment for post-prostatectomy incontinence. Urodynamics have been used to have a better understanding of the anatomical and functional changes in incontinent men after radical prostatectomy; however, the role of urodynamic testing to assess these patients and offer treatment is still to be determined.

     

Treatment of Stress Urinary Incontinence in Women with Urethral Hypermobility and Intrinsic Sphincter Deficiency

Purpose

We compared 2 treatment modalities (sling cystourethropexy and periurethral collagen injection) in patients with intrinsic sphincter deficiency alone or with urethral hypermobility (combined stress urinary incontinence).

Materials and Methods

We retrospectively reviewed a series of 50 consecutive patients treated surgically for intrinsic sphincter deficiency during a 2-year period. All patients were evaluated by history and physical examination to assess urethral hypermobility and urodynamic testing. Intrinsic sphincter deficiency was assessed by abdominal leak point pressure and video urodynamics. Of the 50 patients 28 underwent a pubovaginal sling operation and 22 received a periurethral injection of collagen.

Results

Of the patients studied 40 percent had combined stress urinary incontinence. A pubovaginal sling procedure resulted in a cure rate of 81 percent in this group, compared to 25 percent for periurethral injection of collagen.

Conclusions

A subgroup of women exists with combined stress urinary incontinence due to urethral hypermobility and intrinsic sphincter deficiency. When treated with sling cystourethropexy women with combined stress urinary incontinence do as well or better than those with intrinsic sphincter deficiency alone and those treated with periurethral collagen injection do worse.     

Feasibility of Urodynamic Study (Combined Cystometry and Electromyography of the External Urethral Sphincter) under General Anesthesia in Children

Background To assess the feasibility of urodynamic study under general anesthesia (GA) we performed electromyography of the external urethral sphincter (EUS-EMG) on 73 children and cystometry (CM) alone on 10 children.
Methods Subjects were divided into 3 groups. Those in groups I and II were suspected of having voiding dysfunction with (group I) or without (group II) overt neurospinal defects, while those in group III were thought to be functionally normal. EUS-EMG was performed under light anesthesia following cystourethroscopy to examine structural abnormalities. Atropine sulfate premedication was not used for the anesthetic procedure; muscle relaxants were used only for tracheal intubation.
Results Voiding was observed in 83% of the patients. Among patients who voided, detrusor-external sphincter dyssynergia (DSD) was noted in 7 (38%) group I patients and 6 (19%) group II patients; in group III, voiding was synergic in all patients. In 10 cases, CM alone was carried out both under anesthesia and in the waking state; anesthesia suppressed detrusor hyperreflexia (DH) in all 9 patients but produced no change in bladder compliance.
Conclusions In children with urinary disorders, urodynamic study under GA following cystourethroscopy is a feasible method for assessing EUS function and documenting DSD; DH is not evaluable, however. Stratifying urinary management on the basis of these examinations resulted in satisfactory clinical outcomes.     

尿道狭窄的尿动力学检查及其临床意义

对178例尿道狭窄(US)病人行尿动力学检查。包括尿流率(UFR)、膀胱测压、排尿期膀胱尿道造影和电视下的尿道功能观察。对UFR与临床症状体征的关系、最大尿流率(Qmax)、相对尿道阻力(RVR)与综合性尿动力学检查判断US和术后疗效的临床意义进行了讨论。作者强调了Qmax、UFR曲线形态对早期诊断US与评价术后疗效的重要性。