THE ETIOLOGY OF POSTRADICAL PROSTATECTOMY INCONTINENCE AND CORRELATION OF SYMPTOMS WITH URODYNAMIC FINDINGS

Purpose: We evaluated men with post-radical prostatectomy incontinence to determine the incidence of intrinsic sphincter deficiency and blad der dysfunction, and the contribution of each to incontinence. In addi tion, we determined if subjective symptoms of stress urinary incontine nce and urge incontinence correlated with urodynamic findings of intri nsic sphincter deficiency and bladder dysfunction, respectively. Mater ials and Methods: A total of 60 consecutive patients (mean age 64.8 ye ars) were prospectively evaluated with multichannel video urodynamics. All patients were evaluated at least 6 months postoperatively and had achieved a stable level of continence. Patients characterized inconti nence as stress or urge related, and stress urinary incontinence was g raded from 0 to 3. Intrinsic sphincter deficiency was defined as incon tinence associated with increased intraabdominal pressure and was furt her assessed by Valsalva's leak point pressure. Bladder dysfunction in cluded urodynamic findings of detrusor instability or decreased compli ance. Results: Intrinsic sphincter deficiency was demonstrated in 54 p atients (90%). Some component of bladder dysfunction was seen in 27 pa tients (45%), including detrusor instability in 24 and decreased compl iance in 3, but incontinence was actually a result of bladder dysfunct ion in only 16 (27%). Incontinence was due to intrinsic sphincter defi ciency alone in 40 patients (67%), intrinsic sphincter deficiency and bladder dysfunction in 14 (23%), and bladder dysfunction alone in only 2 (3%). Incontinence was not demonstrated on video urodynamics in 4 p atients (7%). Of the 57 men who complained of stress urinary incontine nce 54 demonstrated intrinsic sphincter deficiency for a positive pred ictive value of 95%. The 3 patients without stress urinary incontinenc e did not demonstrate intrinsic sphincter deficiency for a negative pr edictive value of 100%. Positive and negative predictive values for ur ge incontinence were 44 and 81%, respectively. Conclusions: Incontinen ce after radical prostatectomy is associated with intrinsic sphincter deficiency in the overwhelming majority of patients. Bladder dysfuncti on rarely is an isolated cause. When present on urodynamic tests bladd er dysfunction may not always be a significant contributor to incontin ence. The symptom of stress urinary incontinence (or its absence) accu rately predicts the finding (or absence) of intrinsic sphincter defici ency on urodynamics. Urge incontinence is not as reliable in predictin g incontinence due to bladder dysfunction.