SPHINCTERIC INCONTINENCE - THE PRIMARY CAUSE OF POSTPROSTATECTOMY INCONTINENCE IN PATIENTS WITH PROSTATE-CANCER

Post-prostatectomy incontinence in patients with cancer of the prostat e is often the result of sphincteric injury. However, recent studies h ave emphasized the role of detrusor instability and decreased bladder compliance in the etiology of post-prostatectomy incontinence. To furt her clarify the primary cause of incontinence, we reviewed the urodyna mic studies of 39 patients referred for evaluation of incontinence aft er prostatectomy (35 radical, 4 TURF and radiation) for prostate cance r. Multichannel videourodynamic studies were performed to characterize bladder function, and sphincteric incontinence was assessed by Valsal va leak point pressure (VLPP). Flexible cystourethroscopy was used to evaluate the vesicourethral anastomosis. A pad scoring system was used to measure symptom severity. Sphincteric damage was found to be the s ole cause of urinary incontinence in 23 patients (59%) and a major con tributor in 14 others (36%). Twenty-seven patients (69%) had VLPP less than 103 cmH(2)O (mean = 55) with a urethral urodynamic catheter in p lace. An additional 10 (26%) had VLPP less than 150 cmH(2)O (mean = 63 ) upon removal of the catheter. VLPP is an indication of the severity of sphincteric damage. The importance of removing the urodynamic cathe ter during measurement of the VLPP is emphasized. Urethral fibrosis wa s confirmed by cystourethroscopy in 26 (67%) patients. Bladder dysfunc tion characterized by detrusor instability and/or decreased bladder co mpliance was seen in 15 patients (39%). In contrast to previous studie s, our results indicate that sphincteric damage, and not bladder dysfu nction, accounts for the vast majority of post-prostatectomy incontine nce in patients with prostate cancer. However, it is essential to iden tify and treat bladder dysfunction in order to optimize the outcome of treatment for sphincteric incontinence. (C) 1997 Wiley-Liss, Inc.