Incontinence after radical prostatectomy: detrusor or sphincter causes

Prospective studies have shown a high prevalence of decreased compliance immediately after radical prostatectomy, which may be a temporary phenomenon in men in whom incontinence persists for more than 1 year. We examined the video urodynamic records of 74 consecutive men referred to our urodynamic laboratory with incontinence as the predominant symptom following radical prostatectomy to evaluate voiding parameters and bladder function.

The urodynamic assessment was made an average of 3.8 years postoperatively. All men presented with persistent post-prostatectomy incontinence, and 64 underwent radical retropubic and 10 radical perineal prostatectomy.

A total of 42 men (57%) had sphincter weakness alone, 29 (39%) had detrusor instability and/or decreased compliance combined with sphincter weakness and only 3 (4%) had detrusor instability alone. Of 29 men with a combination of factors 8 had decreased compliance, with 3 also having detrusor instability. Anastomotic strictures occurred in 24% of the patients. A total of 31 patients voided by straining without demonstrable detrusor contraction (42% overall).

Decreased compliance is an infrequent finding after radical prostatectomy. Detrusor abnormalities in general are rarely the sole cause of incontinence, with sphincter weakness being present in the majority of patients.