Do clinical or urodynamic parameters predict artificial urinary sphincter outcome in post-radical prostatectomy incontinence?
OBJECTIVE
To determine whether urodynamic or clinical parameters can predict artificial urinary sphincter (AUS) outcome in patients who were incontinent after radical prostatectomy (RP). Incontinence after RP is secondary to intrinsic sphincter deficiency, but urodynamics have been advocated before AUS placement to detect factors that could limit surgical success.


METHODS
We reviewed all AUSs placed for RP incontinence from January 1995 to December 2004. The preoperative clinical parameters and urodynamic parameters were correlated with surgical success using linear and logistic regression analysis, respectively. Surgical failure was defined as requiring more than one pad per day.


RESULTS
The data from 86 patients (mean age 72 years) were analyzed. Of these 86 patients, 15 (17%) were wearing more than 1 pad per day at the last follow-up visit; 11 patients (13%) considered their operation a failure; and 20 patients (24%) had postoperative urgency. The presence of detrusor overactivity (P = 0.92), low first sensation (P = 0.52), low bladder compliance (P = 0.38), and bladder capacity less than 300 mL (P = 0.58) in patients did not predict for AUS failure compared with patients without these findings. No clinical parameters were found that demonstrated a statistical association with the number of pads per day. Older patients considered themselves less improved (P = 0.012) than did younger patients.


CONCLUSIONS
No evidence has shown that patients who are incontinent after RP who have detrusor overactivity, a low first sensation, decreased compliance, or a low bladder capacity have worse post-AUS outcomes than other patients. Older patients tended to have decreased perceived improvement. We found no clinical or urodynamic parameter that would be a contraindication to AUS placement for post-RP incontinence.
Thiel
David D
DD
Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA.
Young
Paul R
PR
Broderick
Gregory A
GA
Heckman
Michael G
MG
Wehle
Michael J
MJ
Igel
Todd C
TC
Petrou
Steven P
SP
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014554:Urination / Q000502:physiology; D014563:Urodynamics
D017430:Prostate-Specific Antigen