Can filling phase urodynamic parameters predict the success of the bulbar artificial urinary sphincter in treating post-prostatectomy incontinence?
OBJECTIVE
To evaluate whether filling phase urodynamic parameters can predict the success of the artificial urinary sphincter (AUS) in treating post-prostatectomy incontinence (PPI).


METHODS
We reviewed the pre-AUS urodynamics of 99 patients with PPI at two tertiary referral centers. We documented the peak DO pressure (Pdet), capacity, and compliance (C). We defined success as patient-reported continence or only using one safety pad. Patients' perception of improvement was assessed using the PGI-I score.


RESULTS
Sixty-eight percent (n = 68) of patients had a successful outcome. The mean compliance for the "success" and "failure" group was 112.3 mL/cmH2O (±119.7) and 34.1 mL/cmH2O (±36.2), respectively. Fifty-five percent (17/31) of patients in the "failure" group demonstrated DO(Pdet= 36.2 ± 18.2 cmH2O) compared to 18% (12/68) in the success group. The differences between the two groups in Pdetand compliance were statistically significant (all P < 0.01). There was, however, no statistical difference between the mean cystometric capacities of patients in the two outcome groups. Thirteen out of 18 (72%) patients who had radiotherapy had a poor outcome ("success" group only 15% [9/59]). These results were used to develop a nomogram for the probability of AUS success. A good inverse correlation (r = -0.65) was demonstrated between the probability of AUS success as deduced from the nomogram and PGI-I score post-AUS implantation CONCLUSION: Compliance and Pdetare predictors of outcome following AUS implantation for PPI. We have developed and internally validated a nomogram that may be used to determine an individualized likelihood of AUS success. This nomogram may be used as a counseling tool to objectively set realistic expectations of continence post-AUS implantation.
University College London Hospital, London, United Kingdom.
Eskinder
E
Solomon
Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Rajan
R
Veeratterapillay
University College London Hospital, London, United Kingdom.
Sachin
S
Malde
Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Christopher
C
Harding
University College London Hospital, London, United Kingdom.
Tamsin Jillian
TJ
Greenwell
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics / Q000502:physiology*
artificial urinary sphincter; prostatectomy; radiotherapy; urinary incontinence; urodynamics