title: Absence of urethral post-void milking: an additional cause for incontinence after radical prostatectomy?
abstract: OBJECTIVE
  Urinary incontinence following radical prostatectomy is thought to be mainly due to stress leak as a result of sphincter insufficiency or detrusor dysfunction. However, a number of patients complain of stress-independent urinary leakage following voiding, i. e. a post-micturition dribble, of uncertain origin. In order to establish wether post-micturition dribble is related to altered post-void milking in the urethra, voiding cystourethrograms (VCUGs) were performed before and after radical prostatectomy and correlated with the presence of post-micturition dribble.
  
  
  METHODS
  23 VCUGs were recorded before and 19 VCUGs at 10-15 days following radical prostatectomy. A standard questionnaire regarding urinary symptoms was given to all patients pre- and postoperatively at defined intervals.
  
  
  RESULTS
  12 of 19 patients (63%) had post-void urethral milking prior to surgery, none of these reported post-micturition dribble. 6 of the 7 patients (86%) without post-void urethral milking reported post-micturition dribble. Postoperatively only 1 of 16 patients (6%) had post-void urethral milking. Of the 15 patients without postoperative urethral milking, 13 (87%) reported post-micturition dribble. The decrease in rate of milking and increase in rate of post-micturition dribble from before to after surgery was statistically significant (chi(2) test, p = 0.0001 and p<0.0001, respectively.
  
  
  CONCLUSIONS
  These data suggest that post-void milk-out of the urethra is often absent in the early postoperative period after radical prostatectomy and that this is associated with post-micturition dribble. Aside from detrusor and sphincter dysfunction, urethral dysfunction, i.e. the absence of urethral post-void milking, seems to be an additional cause of incontinence following radical prostatectomy.
authors.affiliation: Department of Urology, University of Berne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Wille
authors.forename: R D
authors.initials: RD
authors.lastname: Mills
authors.forename: U E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011859:Radiography; D014521:Urethra / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000000981:diagnostic imaging / Q000209:etiology*