Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study

Area of Science:

• Urology
• Surgical Oncology
• Pelvic Floor Dysfunction

Background:

• Radical retropubic prostatectomy (RRP) is a common treatment for prostate cancer.
• The impact of RRP on bladder function, specifically detrusor and sphincter function, requires longitudinal assessment.

Purpose of the Study:

• To evaluate the 3-year urodynamic effects of RRP on detrusor and sphincter function.
• To compare preoperative urodynamic status with longitudinal follow-up data after RRP.

Main Methods:

• Prospective study of 54 patients undergoing RRP.
• Urodynamic assessments including pressure-flow studies and Valsalva leak point pressure measurements at baseline, 8 months, and 3 years post-surgery.
• Analysis of bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD).

Main Results:

• Significant increase in reduced bladder compliance and de novo detrusor hypocontractility observed at 8 months, persisting in approximately 25-30% of patients at 3 years.
• Detrusor hypocontractility was associated with DO and ISD in a significant proportion of patients.
• No patients experienced postvoid residual volume, suggesting compensatory voiding mechanisms.

Conclusions:

• RRP can lead to de novo detrusor hypocontractility, decreased bladder compliance, and intrinsic sphincter deficiency, likely from bladder denervation.
• These dysfunctions become established in about 30% of patients over time.
• Patients adapt their voiding behaviors, mitigating symptomatic presentation despite urodynamic changes.