Aim
of
this
study:
Incontinence
from
radical
retropubic
prostatectomy
(RRP)
has
been
reported
to
occur
in
2%
to
87%
of
patients,
and
is
generally
believed
to
be
due
to
bladder
dysfunction,
sphincter
dysfunction
or
a
combination
of
these
2
factors.
Some
studies
have
shown
a
decrease
in
detrusor
compliance
following
RRP.
In
view
of
the
various
factors
that
may
play
a
role
in
post
RRP
incontinence,
we
analyzed
urodynamic
studies
from
patients
who
underwent
RRP
to
determine
the
differences
in
urodynamic
findings
between
continent
and
incontinent
patients.
Methods:
Comprehensive
video-urodynamic
studies
were
performed
between
five
and
24
months
postoperatively
in
33
patients
who
underwent
radical
retropubic
prostatectomy.
The
following
parameters
were
recorded:
cystometric
capacity,
bladder
compliance,
maximum
isometric
contraction
pressure
(Pisv),
maximum
voiding
pressure
during
steady
flow
state
(PdetmaxSF)
and
post
residual
volume
(PVRV).
Post
RRP
bladder
outlet
obstruction
was
defined
as
PdetmaxSF
>50cm
H2O.
The
patients
were
divided
into
2
groups:
incontinent
patients
(n
=
17)
and
continent
patients
(n
=
16),
i.e.
those
patients
who
claimed
to
be
dry
and
who
wore
no
protection.
Results:
The
urodynamic
data
for
the
two
groups
are
shown
in
the
table:
(*p
=
<
0.05).
Six (35%) patients in the incontinent group and 11 (69%)
patients
in
the
continent
group
had
bladder
outlet
obstruction
at
the
site
of
anastomosis.
Both
PdetmaxSF
and
compliance
were
significantly
higher
in
the
incontinent
group
(65%)
than
in
the
continent
group
(13%).
Pisv
was
not
significantly
different
between
groups.
Detrusor
instability
was
present
in
8
(47%)
incontinent
patients
and
in
8
(50%)
continent
patients.
|
|
Pisv
(cm H20)
|
Pdet.maxSF
(cm
H2O)
|
Capacity
(ml)
|
PVRV
(ml)
|
Compliance
(ml/cm
H2O)
|
|
Incontinent
patient
(±SD)
|
86.5
(29)
|
50.5
(18)*
|
340
(109)
|
55
(74)
|
26
(9)*
|
|
Continent
Patients
(±SD)
|
80.2
(30)
|
71.8
(30)*
|
453
(223)
|
117
(56)
|
39
(14)*
|
Conclusion:
This
study
suggests
that
some
degree
of
outlet
obstruction
at
the
site
of
the
anastamosis
together
with
preservation
of
compliance
may
contribute
to
maintaining
continence
after
RRP.
The
presence
of
a
critical
degree
of
outlet
resistance
after
RRP
may
augment
the
distal
sphincter
mechanism,
provided
that
the
remainder
of
the
distal
sphincter
is
intact.
