Weak VLPP and MUCP correlation and their relationship with objective and subjective measures of severity of urinary incontinence

The aims of the present study were to find the correlation between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) and to determine whether the water perfusion maximum urethral closure pressure (MUCP) correlates with VLPP. Seventy-nine women with previously untreated stress urinary incontinence were recruited to participate in a clinical study. Their mean age was 56.4 years, mean BMI was 27.8, and mean parity was 1.9. The mean values of VLPP and CLPP were 50.4 and 52.9 cm H₂O, respectively. We did not find statistically significant differences in the mean values of VLPP and CLPP. The mean value of MUCP at rest was 44.2 cm H₂O and the mean value of MUCP during maximal Valsalva maneuver was 37.2 cm H₂O; with 500 ml of sterile saline in the bladder the difference between them is statistically significant. In the study group (n=79), 56 patients (77%) had low VLPP (≤60 cm H₂O), 21 patients (30%) had low MUCP (≤30 cm H₂O), and 8 patients had MUCP≤20 cm H₂O (all at rest). Of the 56 patients with low VLPP, 16 also had a low MUCP (≤30 cm H₂O). This study mainly compares two parameters—the MUCP and the VLPP. Based on our results we can conclude that there is no correlation between these parameters. MUCP measures urethral resistance at rest and VLPP measures urethral resistance during increased intra-abdominal pressure (Valsalva maneuver). This work was supported by the Grant Agency of the Ministry of Health of the Czech Republic, grant NH 7378-3.     

A comparison of the cough and standing urethral pressure profile in the diagnosis of stress incontinence

Controversy over the accuracy of the urethral pressure profile (UPP) and its role in the diagnosis of stress urinary incontinence (SUI) is unresolved. Different UPP methods and techniques have been introduced. In this study, we examined 78 female patients with mixed symptoms of stress and urge incontinence. Each had a history, physical examination, cystoscopy, and urodynamic assessment, which consisted of a cystometrogram (CMG), UPP (supine and standing), and “cough profile” by the Brown and Wickham (BW) method and also UPP (supine) and “cough profile” with the microtip transducer (MTT). The final diagnosis in 38 patients was SUI (group I) and in 40 patients, no SUI (group II). The maximum urethral closure pressure (MUCP) supine and standing was significantly lower in group I, but there was no significant difference between the two groups in the transmission index (TI) of the “cough profile.” MUCP standing showed the least overlap between the two groups, and with a cutoff point at 40 cm H₂O, the overall diagnostic accuracy was 69%, with 39% sensitivity and 98% specificity. By combining MUCP supine and standing and using cutoff points at 40 cm H₂O and 35 cm H₂O, respectively, the overall diagnostic accuracy was 72%, with 47% sensitivity and 95% specificity. We believe that the UPP is a useful ancillary tool in the assessment of complicated cases of urinary incontinence in the female.     

Continuous recording of urethral activity in healthy female volunteers

The pressure variations at the maximal urethral closure pressure (MUCP) were continuously recorded in healthy female volunteers by means of a two-point microtip transducer catheter for one hour. Before the investigation a normal voiding was assured objectively and bladder instability was excluded. All women showed pressure variations both at the MUCP and more distally. The pressure variations, from 3 to 66 cm H₂O, showed rhythmicity and three frequency ranges could be identified. Slow pressure waves with a frequency of one in eight to 19 minutes were observed. Relatively fast-pressure waves were observed (one every one to four minutes) and relatively fast-frequency pressure waves were observed (rate: one to eight per minute). The pressure variations of the urethra seem to be an aspect of normal urethral physiology possibly contributing to continence and urinary tract infection prevention.     

The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure

The objective of this study was to estimate the cure rate and to identify risk factors that predict failure of the tension-free vaginal tape (TVT) in women with stress urinary incontinence (SUI), a non-hypermobile urethra, and low maximum urethral closure pressure. Thirty-six women with SUI, a non-hypermobile urethra (straining urethral angle ≤35°), and low maximum urethral closure pressure (MUCP ≤25 cm H₂O) underwent a TVT. Cure was defined as resolution of subjective SUI symptoms and a negative cough stress test, which were measured after 4, 12, 18, and 24 months. Patient characteristics were compared and receiver–operator curves were used to identify risk factors for failure. The mean age was 71 years, and mean follow-up was 20.9 months. The overall cure rate was 78%. Risk factors for failure of the TVT were a straining urethral angle ≤20° (cure rate 50%, odds ratio 7.7, p = 0.02) and a MUCP ≤15 cm H₂O (cure rate 60%, odds ratio 6.3, p = 0.03). For women with both risk factors, the cure rate was only 17% (p < 0.001). No other risk factors were identified. The TVT has moderate success (50-60%) for women with SUI and one risk factor (a straining urethral angle </=20 degrees or a MVCP </=15 cm H₂O), but has poor success (17%) when both risk factors are present. Presented at the annual meeting of the Society for Gynecologic Surgeons, Dallas, TX, March 5–7, 2002. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Unstable urethral pressure: Toward a more relevant definition

There is confusion in the literature over the use of the terms unstable urethra and unstable urethral pressure, which are often held inappropriately to be synonymous. The importance of the former condition, as a cause of incontinence, is beyond doubt, although it appears to be an uncommon condition; the finding of unstable urethral pressure is reported much more frequently, although its clinical significance remains in debate. An analysis of urethral pressure recordings in a group of 131 women with urodynamically proven genuine stress incontinence, and 14 urodynamically normal women entirely free from urinary symptoms has been carried out in an attempt to define the differences between the two and thus to establish a more clinically relevant definition for the phenomenon of “unstable urethral pressure.” The variation in urethral pressure was calculated first in absolute terms, as the variation in cm H₂O above and below the mean maximum urethral closure pressure (MUCP), and second in relative terms, as a percentage of the mean MUCP itself; these two parameters are described as “delta-MUCP (absolute)” and “delta-MUCP (relative),” respectively. The mean delta-MUCP (absolute) values were 9.5 and 13.4 cm H₂O for the symptomatic and control groups, respectively (not significant); the mean delta-MUCP (relative) values were 27.0% and 17.1% of the MUCP (p < 0.001). Examination of various potential points of discrimination for the diagnosis of “unstable urethral pressure” showed a delta-MUCP (relative) of 30% to be the best discriminator, allowing the identification of a subgroup of stress incontinent women whose urethral pressure variation was likely to be of relevance in the determination of symptoms.     

Correlation between valsalva leak point pressure and maximal urethral closure pressure in women with stress urinary incontinence

This study analyzed the relationship between valsalva leak point pressure (VLPP) and maximal urethral closure pressure (MUCP) in women with stress urinary incontinence. One hundred sixty-one patients were selected with diagnosis of mixed or stress urinary incontinence. During urodynamics we measured VLPP and MUCP. Patients were gathered according to VLPP and analysis of variance (ANOVA) was performed. Pearsons correlation coefficient and linear regression were also utilized. The group with VLPP under 60 cm H₂O had mean MUCP of 44.5 cm H₂0; the group with VLPP between 60 and 90 cm H₂O had mean MUCP of 54.3 cm H₂O; and the group with VLPP over 90 cm H₂O had mean MUCP of 60.1 cm H₂O. We observed correlation between MUCP and VLPP when we used Pearsons correlation coefficient (r=0.22) and linear regression (p<0.05). There was weak correlation between MUCP and VLPP, and MUCP was significantly lower in patients with leak point pressure inferior to 60 cm H₂O. Editorial Comment: This is a retrospective study of 161 female patients with stress urinary incontinence in which the authors analyze the relationship between urodynamic valsalva leak point pressure (VLPP) and maximal urethral closure pressure (MUCP). In analyzing their data with Pearsons correlation coefficient and linear regression, the authors found a weak correlation between VLPP and MUCP. In addition, they found a significantly lower MUCP in patients with VLPP less than 60. The authors conclude that MUCP values less than 45 cm H₂O are not sensitive in diagnosing intrinsic sphincter deficiency. Although this study supports the known correlation between VLPP and MUCP, it adds little new information to the literature. This subject has previously been studied and evaluated and numerous published articles have already confirmed this correlation. It is already generally accepted that the diagnosis of intrinsic sphincter deficiency should be based on a compilation of factors including patient history, urodynamic, anatomic, and clinical severity criteria     

Urethral pressure and pressure variations in stress incontinent women and women with unstable detrusor

The urethral pressure and pressure variations were studied in ten genuine stress incontinent women and twenty-six women with unstable detrusor based on 1 hour recordings. In the stress incontinent women the mean maximum urethral pressure (mMUP) calculated from 1 hour continuous urethral pressure recordings was 49 cm H₂O and the mean maximum urethral closure pressure (mMUCP) was 38 cm H₂O. When analysed in relation to previous data from healthy women the mMUP and the mMUCP were significantly reduced. The urethral pressure variation (UPV) is a normal physiological activity of the urethra, also occurring in stress incontinent and unstable detrusor patients. The UPV amplitude of the stress incontinent women was reduced, indicating that the UPVs are related to the baseline pressure in urethra but still part of the complex pathophysiological changes occurring in urethra during stress incontinence. In the unstable detrusor group the parameters were within the range of the normal material except for the abrupt urethral pressure drop followed by detrusor contraction. However, these events were clearly different from the rhythmic urethral pressure variations which seem to discern from the pathogenesis of the unstable detrusor.     

Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure <20 cm H₂O and a Valsalva leak point pressure <60 cm H₂O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3–36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.     

Effect of voluntary attention on urethral pressure

We have systematically and simultaneously recorded vesical pressure and maximum urethral closure pressure (MUCP) in 109 women consulting for urinary incontinence over an extended period of time. During the recording, we asked them to peform a mental calculation (MC) test and other tests designed to induce an effort of voluntary attention. We found a significant increase in MUCP during the MC. At rest, 57 women displayed urethral pressure variations (UPV) higher than 15 cm H₂O. MC inhibited UPV in 80% of these cases. Such variations have never yet been reported. The effect of MC can be compared to an orienting reaction, which normally increases the sympathetic tonus. The role of the smooth and striated muscle fibers of the urethra, in the observed changes in urethral pressure, is discussed in light of the literature data.     

Rhythmic pressure variations in urethra and anal canal: Investigations in healthy fertile female volunteers

Ten healthy fertile female volunteers underwent one hour continuous urethral and anal canal pressure recordings. The recordings showed a median maximum urethral pressure (mMUP), of 74.0 cm H₂O and a median maximum anal canal pressure (mMAP) of 50.0 cm H₂O. The anal canal pressure variations (APV) showed the same frequency domains as found in the urethra ranging from 0.001 to 0.03 Hz. The APV amplitude was correspondingly diminished and the two pressure tracings were out of phase indicating the urethral pressure variations (UPV) and APV to be separate intrinsic spontaneous activities of the urethra and anal canal. Twenty-six months prior to the present study the women had a similar urethral pressure recording. Comparison of the mMUP, maximum urethral closure pressure (mMUCP), and UPV frequency and amplitude showed no difference between the two periods. The intraindividual variation was lower than the interindividual variation meaning that the individual woman had rather stable urethral pressures, whereas there was a considerable variation between the women. The rhythmic UPV frequencies and amplitudes were stable during the two year period. Consequently the study underlines the consistency of urethral pressure. The comparative investigations of urethral and anal pressure add evidence to our pressure statements that they originate from smooth muscle activity.     

Tension‐free vaginal tape retropubic sling for recurrent stress urinary incontinence after Burch colposuspension failure

Objectives: To verify the efficacy and to clarify the mechanism of the tension‐free vaginal tape retropubic sling for recurrent stress urinary incontinence after Burch colposuspension failure. Methods: A total of 24 women having tension‐free vaginal tape retropubic sling placement for recurrent stress urinary incontinence after a previous failed Burch urethropexy were enrolled in the present study. Median follow up was 57 months (range 12–96). Pre‐ and postoperative urethral mobility and urodynamics were evaluated. Results: Preoperatively, all 24 patients had intrinsic sphincter deficiency and 14 had urethral hypermobility. Postoperatively, 15 patients were completely dry and two had a leakage of urine less than 5 g/h. The overall success rate was 70.8%. There was a significant postoperative increase of maximum urethral closure pressure (P < 0.001), and a decrease of average flow rate (P = 0.001) and urethral hypermobility (P < 0.001). When comparing successful with failure cases, only elevated maximum urethral closure pressure (P = 0.002) was significantly different. Multivariate logistic regression showed the change of maximum urethral closure pressure (P = 0.011) was the only independent parameter significantly correlated with the outcome of sling placement. Conclusions: Recurrent stress urinary incontinence with intrinsic sphincter deficiency after Burch colposuspension might be well treated with the tension‐free vaginal tape retropubic sling by effectively elevating the maximum urethral closure pressure.     

Is the leak point pressure alone an accurate indicator of intrinsic sphincteric deficiency?

The aim of this study was to determine the characteristics of women who meet the criteria for intrinsic sphincteric deficiency (ISD) on maximum urethral closure pressure (MUCP) but not on leak point pressure (LPP) measurement. We performed a cross-sectional chart review of every patient who underwent multichannel, microtransducer urodynamic testing in our center between 1994 and 1996 (n=423). From this population we culled a sub-population of women who fit into one of the following two groups: women with no evidence of ISD on MUCP or LPP and women with evidence of ISD on MUCP only. Logistic regression was used to identify independent predictors of group membership. Increasing age (>60.5 years) and a positive supine empty stress test were the only independent predictors of membership in the group of women with ISD on MUCP only. Knowledge of these risk factors may help clinicians in choosing appropriate pre-operative testing.Abbreviations ISD Intrinsic sphincteric deficiency - LPP Leak point pressure - MUCP Maximum urethral closure pressure Editorial Comment: Valsalva leak point pressures and maximum urethral closure pressures are two different tests that can be used to evaluate and quantify urethral sphincteric function. The authors performed a cross-sectional study to determine the characteristics of women whose diagnosis of ISD would be missed based on an abnormal MUCP defined as <20 cm H₂0 if only a LPP was assessed. They found that of 305 patients with a normal LPP defined as >60 cm H₂0, 288 patients also had a normal MUCP (Group A) compared to 17 patients who had an abnormal MUCP (Group B). In comparing 18 patients characteristics, they found that age greater than 60 years and a positive supine empty stress test were independent risk factors for membership in Group B. It is known that both MUCP and LPP are fraught with variables making each difficult to standardize and validate. One could question whether a MUCP with a cutoff <20 cm can truly be used to define ISD. This brings up a related criticism described as a limitation by the authors—mainly that LPP were measured only at a bladder volume of 150 cc. Perhaps if the measurements were repeated at a larger bladder volume, there would have been an even greater correlation between MUCP and LPP. More needs to be done in the future to better standardize tests used to evaluate urethral function. As the authors mentioned, however, with the success of suburethal slings for all types of stress incontinence, perhaps this is a moot point.     

Observations on the function of the female urethra: I: relation between maximum urethral closure pressure at rest and urethral hypermobility

AIMS: To study the relation between maximum urethral closure pressure at rest and urethral hypermobility in female patients. PATIENTS AND METHODS: We selected 255 patients aged 20 years and older, with a stable bladder on multichannel urodynamics, without known neurological pathology, and without a history of pelvic or anti-incontinence surgery. A resting urethral pressure profile and the degree of urethral hypermobility were registered. Two-tailed analyses of variance (ANOVA) with Fisher's post-hoc tests were used to detect any statistically significant difference (P < 0.05) in urethral closure pressure between groups with varying degrees of urethral hypermobility. RESULTS: Mean age was 45.6 +/- 12.7 (range 20-77) years. Mean maximum urethral closure pressure for the entire group was 62.7 +/- 29 (range 10-150) cm of water. A statistically significant inverse relationship was found between age and maximum urethral closure pressure (r = 0.489, P < 0.0001) when both analyzed as continuous variables, and with age categorized in 10-year increments (P < 0.0001). When comparing mean urethral closure pressure in each group examined for urethral hypermobility, a statistically significant difference was noted when grades I, II, and III were compared to grade 0 hypermobility. No significant difference was observed when grades I, II, and III were compared to each other. Even if statistically non-significant, there exists an inverse relationship between the degree of urethral hypermobility and the maximum urethral closure pressure: a higher hypermobility is associated with a lesser urethral closure pressure. CONCLUSIONS: Urethral closure pressure falls significantly when urethral hypermobility is present. This decrease is not related to patient's age or parity. Our observations demonstrate an inverse relation between urethral closure pressure and the degree of cysto-urethrocele. As hypermobility increases, closure pressure decreases, even if this decrease does not reach the level of statistical significance.     

Can simultaneous perineal sonography and urethrocystometry help explain urethral pressure variations?

Objective: To correlate urodynamic with perineal sonographic findings in pressure variations. Patients and methods: In 15 women presenting with urethral pressure variations a urodynamic evaluation with water filling cystometry, urethral pressure at rest and during coughing and uroflowmetry were performed. During water filling cystometry, there were simultaneous perineal video-sonography and urethrocystometry. Video ultrasound images and urodynamic curves were simultaneously monitored on a computer screen. Results: Simultaneous ultrasound and urodynamic evaluation in the 15 patients revealed movements in two areas leading to urethral pressure variations: activity of the pelvic floor muscles and of the urethral sphincter muscles. For the pelvic floor, we found either slow or fast contractions with, respectively, slow (15–30 cm H₂O for 3–10 sec) or fast (30–130 cm H₂O for 1–3 sec) urethral pressure changes. Urethral sphincter contractions were always fast, resulting in fast pressure changes of 30–170 cm H₂O for 1–3 sec. Conclusion: Evaluation of simultaneous perineal sonography and urethrocystometry shows the association of urethral pressure variations and muscle activity. Urethral pressure variations are caused by the activity of urethral sphincter or pelvic floor muscles. With ultrasound the activity of the urethral sphincter muscle can directly be seen whereas pelvic floor muscle activity is indirectly visible. Pelvic floor muscle contractions are either fast or slow, whereas the urethral sphincter muscle contractions are always fast contractions.     

Mechanical properties of the urethra in healthy female volunteers: Static measurements in the resting urethra

A pressure/cross-sectional area probe was used for measurement of related values of pressure (P_ura) and cross-sectional area (CA) at static circumstances in the resting urethra in 30 healthy females. Measurements were performed at the bladder neck in the high-pressure zone and distally in the urethra. From the two variables urethral elastance and hysteresis were calculated. The mean urethral elastance (i.e., dP_ura/dCA) was found to be of the order of 1 cm H₂O/mm² all along the urethra. No correlation could be established between the elastance and age or parity. The mean hysteresis was of the order of 20–25 cm H₂O along the urethra. Urethral hysteresis appeared to be a time-dependent phenomenon.     

Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence

AIMS: To study the relation between maximum urethral closure pressure (MUCP) at rest and the degree of urethral incompetence in the female. PATIENTS AND METHODS: Two hundred fifty five patients aged 20 years or older, with stable bladders on multichannel urodynamics, without known neurological pathology, and with no previous history of pelvic or anti-incontinence surgery were included in the study. Resting urethral pressure profile (UPP) and the grade of urethral incompetence was registered. RESULTS: Mean age of the group was 45.6+/-12.7 years; mean MUCP was 62.7+/-28.5 cm of water. There was a statistically significant difference in the MUCP when the different grades of urethral incompetence were compared to each other, the higher grades being associated with a lower maximal closure pressure. CONCLUSIONS: This study demonstrates that there is a highly significant relationship between MUCP and between all grades of urethral incompetence. This supports previous observations that MUCP decreases when abdominal leak point pressure (ALPP) is low and that this might be secondary to some mechanical failure in the pressure transmission from the abdominal cavity to the urethra. Studies should never compare continent to incontinent cohorts without considering their ALPP because in doing so they are comparing groups that are functionally heterogeneous.     

Intrinsic Sphincter Deficiency: Do the Maximum Urethral Closure Pressure and the Valsalva Leak-Point Pressure Identify Different Pathogenic Mechanisms?

A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure (VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off value for VLPP were 60 cmH₂O and for MUCP 30 cmH₂O. MUCP ≤30 cmH₂O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P= 0.02), more previous urogynecologic operations and the menopause (P= 0.004 and P= 0.000), and older age (P= 0.000). VLPP ≤60 cmH₂O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P = 0.006) and poorer urethral mobility (P= 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence of poor prognostic factors is increased.     

Urethral pressure variations in women with and without neurourological symptoms

Simultaneous urethrocystometry was performed in 93 females without and 174 patients with neurourological symptoms. Both populations were divided into three age groups. The urethral pressure variation (ΔMUP) was calculated as the difference between the highest and the lowest maximum urethral pressure observed during 1 minute. In all age groups, both the highest and the lowest maximum urethral pressure recorded during bladder filling were significantly higher in the normal females than in the patients. There was, however, no significant difference in the degree of ΔMUP between normal females and patients in the different age groups. Typical urethral pressure variation was also observed during physiological bladder filling. Thus, urethral pressure variation in itself is a physiological phenomenon. With less difference between the lowest maximum urethral pressure and the bladder pressure, the possibility of leaking urine is increased. A urethral pressure decrease may therefore cause leakage in a patient but not in a normal female. More than 50% of the normal females had a urethral pressure variation of more than 20 cm H₂O. The previous definitions of urethral pressure variations (unstable urethral pressure, urethral instability), which describe the condition as pathologic when the pressure varies more than 10, 15, or 20 cm H₂O, can therefore no longer be considered useful.     

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises

Fifty-two women, mean age 45.9 years (24–64) with clinically and urodynamically proven stress urinary incontinence (SUI) were randomly assigned to one of two different pelvic floor muscle (PFM) exercise groups. Both groups performed 8–12 maximal PFM contractions 3 times a day for 6 months. In addition one group exercised with an instructor intensively 45 min once a week performing long-lasting contractions with the supplement of 3–4 fast contractions at the end of each long-lasting contraction. Initially and after 6 months an examination was performed comprising history, urinary leakage index, pad test, maximum urethral closure pressure, functional urethral profile length, and recording of vaginal pressure during PFM contractions. The latter was performed monthly. After the treatment 60% of the intensive exercise (IE) group and 17.3% of the home exercise (HE) group reported to be continent or almost continent (P < .01). Only the IE group demonstrated significant reduction in urine loss; from mean 27 g to 7.1 g (P < .01) and improvement in maximum resting urethral closure pressure (mean improvement 4.6 cm H₂O. P = .02). PFM strength improved with mean 15.5 cm H₂O (P < .01) in the IE group while the HE group improved with 7.4 cm H₂O (P < .01). It is concluded that the results of PFM exercise for female SUI is highly dependent upon the degree and duration of treatment and frequent supervision by the therapist.     

Urodynamic changes after radical prostatectomy

Summary Urodynamic examinations were performed in 82 patients with clinically localized prostate cancer before and after radical prostatectomy. A significant decrease in bladder capacity (396 ml to 331.9 ml), urethral closure pressure (89.6 cm H₂O to 65.,2 cm H₂O) and functional profile length (61 mm to 25.9 mm) was noted. The continence rate after radical prostatectomy was 33.4 % after 1 month, 69.4 % after 3 months, 84.7 % after 6 months, and 90.9 % after 12 months, respectively. A correlation was found between urethral closure pressure and functional profile length and continence. A second urodynamic examination was performed 6 months after radical prostatectomy. Functional profile length and urethral closure pressure increased. These data suggest that restoration of continence is based on sphincteric parameters.