Do Clinical or Urodynamic Parameters Predict Artificial Urinary Sphincter Outcome in Post-Radical Prostatectomy Incontinence?

• Published in: Urology (Ridgewood, N.J.) Vol. 69; no. 2; pp. 315 - 319
• Main Authors: Thiel, David D, Young, Paul R, Broderick, Gregory A, Heckman, Michael G, Wehle, Michael J, Igel, Todd C, Petrou, Steven P
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2007; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; Cohort Studies; Follow-Up Studies; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Neoplasm Staging; Nephrology. Urinary tract diseases; Postoperative Complications; Predictive Value of Tests; Preoperative Care; Probability; Prostate-Specific Antigen - blood; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies; Risk Assessment; Treatment Outcome; Urinary Incontinence - etiology; Urinary Incontinence - surgery; Urinary Sphincter, Artificial; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urination - physiology; Urodynamics; Urology; Urine; Artificial sphincter; Nephrology; Urinary system disease; Prognosis; Urinary tract disease; Urology; Urinary incontinence; Urodynamics; Voiding dysfunction; Treatment; Surgery; Parameter; Prostatectomy; Bladder disease; Predictive factor
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2006.10.026

Objectives To determine whether urodynamic or clinical parameters can predict artificial urinary sphincter (AUS) outcome in patients who were incontinent after radical prostatectomy (RP). Incontinence after RP is secondary to intrinsic sphincter deficiency, but urodynamics have been advocated before AUS placement to detect factors that could limit surgical success. Methods We reviewed all AUSs placed for RP incontinence from January 1995 to December 2004. The preoperative clinical parameters and urodynamic parameters were correlated with surgical success using linear and logistic regression analysis, respectively. Surgical failure was defined as requiring more than one pad per day. Results The data from 86 patients (mean age 72 years) were analyzed. Of these 86 patients, 15 (17%) were wearing more than 1 pad per day at the last follow-up visit; 11 patients (13%) considered their operation a failure; and 20 patients (24%) had postoperative urgency. The presence of detrusor overactivity ( P = 0.92), low first sensation ( P = 0.52), low bladder compliance ( P = 0.38), and bladder capacity less than 300 mL ( P = 0.58) in patients did not predict for AUS failure compared with patients without these findings. No clinical parameters were found that demonstrated a statistical association with the number of pads per day. Older patients considered themselves less improved ( P = 0.012) than did younger patients. Conclusions No evidence has shown that patients who are incontinent after RP who have detrusor overactivity, a low first sensation, decreased compliance, or a low bladder capacity have worse post-AUS outcomes than other patients. Older patients tended to have decreased perceived improvement. We found no clinical or urodynamic parameter that would be a contraindication to AUS placement for post-RP incontinence.