Severe postprostatectomy incontinence: Is there an association between preoperative urodynamic findings and outcome of incontinence surgery?

Abstract

Objective.This study investigated urodynamic findings in prostate cancer patients with self-reported persistent severe postprostatectomy urinary incontinence (PPI) as well as the outcome of incontinence surgery. The main aim was to evaluate the ability of preoperative urodynamic dysfunctions to predict the outcome of incontinence surgery. The hypothesis was that preoperative bladder dysfunction was predictive of an unsuccessful surgical outcome. Materials and methods. Based on patient-reported adverse effects after radical prostatectomy (RP) in 2005–2009, 94 men with persistent severe PPI were invited in 2011 to a clinical examination including urodynamics. When indicated, surgery for PPI was offered, and by January 2014, 46 patients had been operated on with either an artificial urinary sphincter or a sling. The outcome of PPI surgery was evaluated with a follow-up questionnaire. Successful outcome was defined in two ways: patient-reported satisfaction and using one or fewer pads/day. Results.Of the 94 men with severe PPI more than 12 months after RP, 76 patients (81% response rate) met for clinical examination. Among them, 99% had intrinsic sphincter deficiency, in 67% coexisting with urodynamic bladder dysfunction. The presence of preoperative bladder dysfunction was not predictive of the outcome of PPI surgery. Preoperative use of fewer pads, less severe PPI, and a longer interval between RP and PPI surgery were associated with the successful outcome of one or fewer pads/day. Longer duration from RP to PPI surgery was the only preoperative factor associated with the successful outcome of satisfaction. Conclusions.The hypothesis was not supported as the presence of preoperative urodynamic bladder dysfunction was not predictive of the outcome of PPI surgery in this study.

Key Words:

• Artificial urinary sphincter
• postprostatectomy incontinence
• PPI surgery
• radical prostatectomy
• retrourethral transobturator sling
• satisfaction
• urodynamics

Acknowledgements

This work was partly funded by the South-Eastern Health Board of Norway [grant no. 2013044] and the Norwegian Institute for Urology. The authors gratefully acknowledge the skilful support of urotherapist C. M. Solend, who performed all the urodynamic investigations on which a substantial part of this article was based, and the contributors to the OUH and NUCG VII studies, especially A. Stensvold MD, PhD and E. A. Steinsvik MD, PhD.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.