Login to Access Video or Poster Abstract: MP63-17
Sources of Funding: None

Introduction

Urinary incontinence after radical prostatectomy is aetiologically diverse, and not solely confined to post-surgical stress urinary incontinence (SUI). Previous studies have shown overall incidence of detrusor overactivity (DO) in this group ranging between 25-63%. With increasing treatment options for overactive bladder and new surgical procedures for male SUI, we aimed to evaluate the impact of urodynamic study findings on subsequent management in a contemporary cohort of patients with post prostatectomy incontinence.

Methods

Prostate cancer patients with urinary incontinence post open radical prostatectomy, who had failed conservative management and being considered for surgical treatment underwent multichannel urodynamic studies between 2011 and 2015. Patients with adjuvant or salvage radiotherapy, as well as those who have undergone previous surgical treatments for SUI were also included. Urodynamic findings were reviewed and subsequent patient management outcomes obtained from medical records. Patients who had laparoscopic or robotic radical prostatectomies were excluded, as were patients treated with radiotherapy alone.

Results

145 patients (age 50-87, median 69) were included. Prior to urodynamic study, 41 patients had adjuvant or salvage external beam radiotherapy, 20 had prior SUI surgery, and 5 had both. Overall, DO was demonstrated in 59 patients and 57 had reduced compliance on filling. DO was found in 55.0% (11/20) of patients with persistent incontinence following previous SUI surgery. DO was present in 48.8% (20/41) of patients with previous radiotherapy and 37.5% (39/104) of patients without previous radiotherapy. In patients with DO, 42.4% (25/59) were treated with anticholinergics, mirabegron or intravesical onabotulinumtoxinA, and did not proceed to SUI surgery. 22.0% (13/59) of patients with DO were managed with SUI surgery alone and 13.6% (8/59) received treatment for DO prior to undergoing SUI surgery. In contrast, only 4.6% (4/87) of patients without DO required treatment with anticholinergics, mirabegron or onabotulinumtoxinA, either in isolation or combined with SUI surgery.

Conclusions

Bladder dysfunction is an important cause of post prostatectomy incontinence in addition to sphincter insufficiency. A significant proportion of such patients can be successfully treated without requiring surgical treatment. Urodynamic study plays an important role in patient evaluation, and helps to optimise the opportunity for successful treatment outcome by guiding individual patient management.

Funding

None