Post-prostatectomy incontinence: the influence of bladder dysfunction

The urodynamic studies of 38 patients referred for evaluation of incontinence after prostatectomy were reviewed. Only 15 patients (39.5 per cent) had pure sphincteric insufficiency as the sole cause of the incontinence. Of the 38 patients 16 (42 per cent) had sphincteric insufficiency combined with a significant component of bladder dysfunction (detrusor instability and/or low bladder wall compliance) as the cause of the incontinence. A total of 7 patients (18.5 per cent) had no evidence of sphincteric insufficiency but they had post-prostatectomy incontinence solely caused by detrusor instability and/or low bladder wall compliance. Of the patients referred for post-prostatectomy incontinence 60.5 per cent had bladder dysfunction as a major factor in the incontinence, which emphasizes the need for comprehensive urodynamic evaluation before treatment is recommended. Of 26 patients whose treatment was based on urodynamic findings and who were available for followup 23 (88 per cent) were adequately continent after treatment, with 35 per cent responding to pharmacological treatment alone and 54 per cent requiring placement of an artificial urinary sphincter with or without associated pharmacological therapy. The potential role of bladder dysfunction as a causative factor in post-prostatectomy incontinence must be considered to optimize the results of treatment and to avoid an unnecessary operation.