Changes of urodynamic findings after radical retropubic prostatectomy

Objectives: We wanted to evaluate the urodynamic changes of radical retropu bic prostatectomy in patients with localized prostate cancer and identify s pecific factors that could influence the postoperative continence status. M ethods: Sixty-six consecutive patients (mean age 68 years) were studied uro dynamically within 1 week before surgery, and 44 of them at a mean 7.6 mont hs after radical intervention. Results: Complete urinary continence was ach ieved in 37/44 men (84.1%) after 6 months and in 43/44 patients (97.7%) 1 y ear after surgery. Stress incontinence of varying degree improved with time . Seven patients demonstrated a moderate incontinence 4 months after radica l prostatectomy and 1/7 was still incontinent after 1 year. Mean flow rate, maximum detrusor pressure, maximum urethral closure pressure (at rest a nd voluntary contraction of the sphincter) and functional urethral length sho wed significant changes after surgery. Detrusor instability, which was pres ent in 31.8% of the 66 patients preoperatively, was not responsible for any case of postoperative incontinence. The urethral pressure profile was sign ificantly reduced in all patients after surgery. Conclusions: The present s tudy indicates that there are no preoperative alterations in bladder functi on such as detrusor instability to identify patients at risk for postoperat ive incontinence. Postoperative incontinence seems to depend upon sphincter ic deficiency as expressed by the reduced pressures in the sphincteric mech anism.