Absence of urethral post-void milking: An additional cause for incontinence after radical prostatectomy?

Objective: Urinary incontinence following radical prostatectomy is thought to be mainly due to stress leak as a result of sphincter insufficiency or d etrusor dysfunction. However, a number of patients complain of stress-indep endent urinary leakage following voiding, i.e. a post-micturition dribble, of uncertain origin. In order to establish wether post-micturition dribble is related to altered post-void milking in the urethra, voiding cystourethr ograms (VCUGs) were performed before and after radical prostatectomy and co rrelated with the presence of post-micturition dribble. Methods: 23 VCUGs were recorded before and 19 VCUGs at 10-15 days following radical prostatectomy. A standard questionnaire regarding urinary symptoms was given to all patients pre- and postoperatively at defined intervals. Results: 12 of 19 patients (63%) had post-void urethral milking prior to su rgery, none of these reported post-micturition dribble. 6 of the 7 patients (86%) without post-void urethral milking reported post-micturition dribble . Postoperatively only 1 of 16 patients (6%) had post-void urethral milking . Of the 15 patients with out postoperative urethral milking, 13 (87%) repo rted post-micturition dribble. The decrease in rate of milking and increase in rate of post-micturition dribble from before to after surgery was stati stically significant (chi(2) test, p = 0.0001 and p<0.0001, respectively. Conclusions: These data suggest that post-void milk-out of the urethra is o ften absent in the early postoperative period after radical prostatectomy a nd that this is associated with post-micturition dribble. Aside from detrus or and sphincter dysfunction, urethral dysfunction, i.e. the absence of ure thral post-void milking, seems to be an additional cause of incontinence fo llowing radical prostatectomy. Copyright (C) 2000 S. Karger AG, Basel.