title: Urodynamic quantification of decrease in sphincter function after radical prostatectomy: relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises.
abstract: OBJECTIVE
  We analyzed the impact of radical retropubic prostatectomy (RRP) on the urethral sphincter function as assessed by urethral pressure profilometry (UPP) and its relation to post-radical prostatectomy continence status. Furthermore, we analyzed the effect of intensive pelvic floor muscle exercises (PFME) on the urethral sphincter function.
  
  
  METHODS
  Sixty-six patients were included in the study. UPP was performed before RRP and 26 weeks after catheter removal. All patients were instructed in PFME, however, the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME).
  
  
  RESULTS
  In 66 patients, pre- as well as postoperative UPP was evaluable. After surgery, the functional profile length and the maximum urethral closure pressure (MUCP) showed a median decrease of 64% and 41%, respectively. For men who had regained continence after 6 months the median MUCP was significantly higher both before and after operation as compared to men who were still incontinent. In multivariate analysis, non-nerve sparing approach was a prognostic factors for a higher relative decrease of the MUCP after RRP. Comparing the PG-PFME group with the F-PFME group there were no significant differences in changes in UPP parameters.
  
  
  CONCLUSIONS
  A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP.
authors.affiliation: Department of Urology, St. Elisabeth Hospital, Tilburg, The Netherlands. y.dubbelman@elisabeth.nl
authors.forename: Yvette D
authors.initials: YD
authors.lastname: Dubbelman
authors.forename: Jan
authors.initials: J
authors.lastname: Groen
authors.forename: Mark F
authors.initials: MF
authors.lastname: Wildhagen
authors.forename: Berend
authors.initials: B
authors.lastname: Rikken
authors.forename: J L H Ruud
authors.initials: JL
authors.lastname: Bosch
mesh_terms: D000368:Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D017773:Pelvic Floor / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D011312:Pressure; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics