Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency.

Area of Science:

• Urology
• Urodynamics
• Pelvic Floor Disorders

Background:

• Radical Retzius Prostatectomy (RRP) can lead to urodynamic bladder dysfunction.
• Understanding the relationship between RRP and bladder dysfunction is crucial for patient outcomes.

Purpose of the Study:

• To analyze the relationship between RRP and urodynamic bladder dysfunction.
• To compare preoperative and postoperative functional status over long-term follow-up.
• To investigate the pathophysiologic mechanisms underlying urodynamic dysfunction.

Main Methods:

• PubMed database search for original articles.
• Review of urodynamic parameters including bladder filling sensation, detrusor overactivity, bladder compliance, cystometric bladder capacity, impaired detrusor contractility, bladder outlet obstruction, and urinary incontinence.

Main Results:

• Detrusor dysfunction rarely occurred as an isolated diagnosis, often coexisting with intrinsic sphincter deficiency.
• Data on various urodynamic parameters were limited and contradictory.
• De novo detrusor overactivity occurred in 2%-77%, impaired compliance in 8%-39%, and impaired contractility in 29%-61% of patients.

Conclusions:

• Postoperative bladder decentralization, inflammation, infection, or geometric alterations are posited causes of detrusor dysfunction.
• Lack of consistent preoperative urodynamic assessment hinders evaluation of the surgery's role.
• Preoperative and follow-up urodynamics are recommended for precise diagnosis, treatment selection, and prevention of postoperative urinary incontinence.