Piotr Radziszewski, Tomasz Borkowski, Andrzej Borkowski, Mariusz Majewski
- Katedra i Klinika Urologii Ogólnej, Onkologicznej i Czynnościowej Uniwersytetu Medycznego w Warszawie
Zakład Fizjologii Klinicznej, Wydział Medycyny Weterynaryjnej, Uniwersytet Warmińsko-Mazurski w Olsztynie
Introduction. Radical prostatectomy (RP) produce neuromuscular damage to the bladder neck and urethra. With the nerve sparring procedure the number of incontinent and impotent patients is decreasing. However, despite meticulous preparation and nerve sparring technique there is still a considerable amount of patients who suffer post-op stress incontinence or who have delayed return of continence.
Objectives. Therefore we wanted prospectively evaluate risk factors which could predict stress incontinence occurrence in patients after radical prostatectomy.
Materials and methods. 20 consecutive patients in the age from 57 to 67 years (mean 65 years) undergoing RP due to prostate cancer were studied. Cystometry, pressure flow studies and urethral pressure profilometry were performed before RP and 3-4 months after the surgery. Outflow obstruction was quantified accordingly to Schaeffer nomogram and maximum urethral closing pressure (MUCP) was considered normal when exceeded 80 cm H2O.
Results. 7 patients preoperatively had low MUCP (from 55-80, mean 65 cm H2O), which in 3 cases was accompanied by significant outflow obstruction (grade IV and more). After RP 3 patients were incontinent (were using more than one pad/day). The MUCP in these patients was low (from 40-80, mean 58 cm H2O). Pressure-flow study demonstrated outflow obstruction in all of them. Both outflow obstruction and low MUCP were also diagnosed in these patients preoperatively.
Conclusions. In this pilot study we were able to identify two important risk factors of early post-operative incontinence. These factors are: low MUCP (below 80 cm H2O) and significant outflow obstruction. Probably these factors determine a delay return of continence. Urodynamics should be advocated in patients before radical prostatectomy as a predictive tool of post-op continence