[Urodynamics study in patients with urinary incontinence, after surgical treatment of localized prostate cancer]

Radical treatment of prostate cancer (PCa) is often associated with the development of urinary incontinence (UI). The etiology of UI after prostatectomy is multifactorial and can be caused by both urethral sphincter deficiency and bladder dysfunction. To date, there are no comparative studies of the development of UI in patients after either organ-preserving treatment or radical prostatectomy (RP). Considering this fact, our aim was to carry out the comparative assessment of urodynamic changes in these categories of patients.

A retrospective study (n=158) was conducted. All patients were divided into three groups, depending on the method of treatment, HIFU (Group 1, n=32), retropubic RP (Group 2, n=46); robot-assisted RP (Group 3, n=80). The mean age was 71.8+/-3.68, 69.5+/-4.63 and 65.8+/-3.4 years in Group 1, 2 and 3, respectively (p<0.01). The average score was ICIQ-SF-14 points. The median follow-up was 2.7 years. In all cases a multi-channel urodynamics study in accordance with ICS standards was performed.

Detrusor overactivity (DO) was detected in 22 (68.7%), 24 (52.1%) and 64 (80%) patients in Group 1, 2 and 3, respectively (p<0.001). In 14% of patients with DO (18%, 12% and 12% Group 1, 2 and 3, p<0.05), leakage test with stress provocative maneuver was negative. The decrease in the bladder compliancy was revealed in 75.9% of patients, and in 8.8% cases (n=14) it was associated with anatomical changes (12.5%, 8.6% and 7.5% in Group 1, 2 and 3, respectively, p<0.01). The mean maximum detrusor pressure was reduced in all patients. Bladder outlet obstruction was detected in 46.6%, 21.7% and 12.5% cases (p<0.001). There was no significant difference in the level of maximum urethral pressure in all groups, but it was significant in patients with negative breakdown at the threshold of abdominal pressure and DO (p<0.05, k=0.87).

The high incidence of postoperative bladder dysfunction in patients of the studied groups revealed by us differs from the existing literature data, which dictates the need for a detailed assessment of bladder dysfunction when choosing a tactic for treating UI. In connection with the above, we consider it necessary to conduct further studies with a mandatory pre- and postoperative urodynamic assessment of the lower urinary tract in patients after surgical treatment of prostate cancer without UI.