A study of pelvic floor function pre- and postradical prostatectomy using clinical neurourological investigations, urodynamics and electromyography

Objectives: Incontinence after radical prostatectomy is addressed to sphinc ter damage and/or bladder dysfunction. Taking into account a high cure rate of incontinence by pelvic floor biofeedback treatment, the search for furt her mechanisms of a complex physiological concept seems feasible. Methods: To characterize pelvic floor function, 18 patients were prospectiv ely evaluated before and after radical prostatectomy by clinical neurourolo gical tests, urodynamics and needle/surface electromyography (EMG). Results: In all patients (mean age 62 years) investigations were completed successfully. The outcomes of neurourological investigations (sacral reflex es, voluntary pelvic floor contraction and relaxation) and needle EMG showe d no significant changes in the pre-/postoperative comparison. Only by usin g surface EMG polygraphy change of activation patterns during pelvic floor contraction (decreased mean and medium frequency) could be found. Conclusion: in patients without preexisting bladder dysfunction and with a basically normal operative and postoperative course, fine motoric changes o f pelvic floor function are the main finding. This cannot be explained by a pure anatomical approach. Neurophysiological events, like a barrage of noc iceptive information, caused by surgical dissection and an inflammatory rea ction due to the healing process, contribute to altered processing within t he central nervous system. The appreciation of these mechanisms, well studi ed in neuroscience and pain research, offers a better understanding of surg ery-related short- and longterm morbidity after pelvic surgery, i.e., urina ry incontinence and erectile dysfunction. Copyright (C) 2000 S. Karger AG, Basel.