Post-Prostatectomy Incontinence: Urodynamic Findings and Treatment Outcomes

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Abstract
We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence. A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocative multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment. Based on the results of urodynamic studies 40 percent of the men had genuine stress incontinence alone and approximately 60 percent had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p less than 0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement. In our large series most men with post-prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define the cause of incontinence but to direct effective therapy.