URODYNAMICS AND THE ETIOLOGY OF POSTPROSTATECTOMY URINARY-INCONTINENCE - THE INITIAL COLUMBIA EXPERIENCE

Post-prostatectomy incontinence is a disabling disorder. Urodynamic st udies in 56 patients with post-prostatectomy incontinence were reviewe d to determine its etiology. Of the patients 31 had undergone transure thral prostatectomy and 25 radical retropubic prostatectomy. After car eful history and neurourological examination, uroflowmetry, post-void residual determination and synchronous multichannel video pressure/flo w studies were done. The most; common etiology for incontinence was de trusor instability alone, which was present in 34 patients (61%), incl uding 24 (77%) after transurethral resection of the prostate and 10 (4 0%) after radical retropubic prostatectomy. Stress incontinence alone was present in only 3 patients (5%), including 1 (3%) after transureth ral resection of the prostate and 2 (8%) after radical retropubic pros tatectomy. Detrusor instability with stress incontinence was present i n 19 patients (34%), including 6 (19%) after transurethral resection o f the prostate and 13 (52%) after radical retropubic prostatectomy. Of these 19 patients 4 (21%) had poorly compliant bladders. This study d emonstrates that stress incontinence alone is a relatively rare cause of post-prostatectomy incontinence, with detrusor instability present in more than 90% of the patients. Accurate diagnosis of post-prostatec tomy incontinence etiology could ensure proper treatment for this diso rder.