Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study.
OBJECTIVE
In a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up.


METHODS
Fifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3-7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD).


RESULTS
There was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo (p<0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up (p<0.05 and p<0.001).


CONCLUSIONS
Following RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.
Giannantoni
Antonella
A
Department of Urology and Andrology, University of Perugia, Perugia, Italy. agianton@tin.it
Mearini
Ettore
E
Zucchi
Alessandro
A
Costantini
Elisabetta
E
Mearini
Luigi
L
Bini
Vittorio
V
Porena
Massimo
M
D000368:Aged; D016009:Chi-Square Distribution; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics