Effect of preoperative urodynamic detrusor overactivity on post-prostatectomy incontinence: a systematic review and meta-analysis.
OBJECTIVE
To investigate whether preoperative urodynamic detrusor overactivity (DO) contributes to post-prostatectomy incontinence (PPI).


METHODS
We systematically searched the online PubMed, Embase, and Cochrane Library databases spanning the period of January 1989 to December 2014.


RESULTS
A total of nine articles met the eligibility criteria for this systematic review. The eligible studies included a total of 457 patients with a median number of 58 patients per study (range 17-92). Of the nine studies, five conducted open retropubic radical prostatectomy (RRP), two performed robot-assisted laparoscopic prostatectomy (RALP), and two others utilized multiple modalities. PPI was more likely to occur in patients with preoperative DO [pooled odds ratio (OR) 2.30; 95 % confidence interval (CI) 1.39-3.82; studies 9; participants 419], as compared to patients who were DO negative. Sensitivity analysis using the subgroups of RRP (OR 2.32; 95 % CI 1.11-4.85), RALP (OR 3.41; 95 % CI 1.55-7.47), DO defined as any amplitude of involuntary contraction (OR 2.32; 95 % CI 1.11-4.85), no postoperative intervention (OR 2.32; 95 % CI 1.11-4.85), and outcome evaluation after 6 months (OR 2.32; 95 % CI 1.11-4.85) demonstrated consistent results. Although some comparisons showed inter-study heterogeneity, there was no clear evidence of publication bias in this meta-analysis.


CONCLUSIONS
Our meta-analysis results suggest that preoperative DO is another possible underlying mechanism for PPI.
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Myong
M
Kim
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Myungchan
M
Park
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Myungsun
M
Shim
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Seung-Kwon
SK
Choi
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Sang Mi
SM
Lee
Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Eun-Sik
ES
Lee
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Cheryn
C
Song
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
Myung-Soo
MS
Choo
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. hjahn@amc.seoul.kr.
Hanjong
H
Ahn
D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics
Detrusor overactivity; Incontinence; Radical prostatectomy; Urodynamic study