Detrusor underactivity is prevalent after radical prostatectomy: A urodynamic study including risk factors

Authors

  • Doreen E. Chung Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; and Section of Urology, University of Chicago Mount Sinai Hospital, Chicago, IL
  • Benjamin Dillon Department of Urology, The Mount Sinai Medical Center, New York, NY
  • Jordan Kurta Department of Urology, The University of Tennessee Health Sciences Center, Memphis, TN
  • Alexandra Maschino Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
  • Jaspreet S. Sandhu Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; and James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY

DOI:

https://doi.org/10.5489/cuaj.192

Abstract

Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population.

Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation.

Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009).

Conclusions: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.

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Published

2013-01-23

How to Cite

Chung, D. E., Dillon, B., Kurta, J., Maschino, A., & Sandhu, J. S. (2013). Detrusor underactivity is prevalent after radical prostatectomy: A urodynamic study including risk factors. Canadian Urological Association Journal, 7(1-2), E33-E37. https://doi.org/10.5489/cuaj.192

Issue

Vol. 7 No. 1-2 (2013): CUAJ January

Section

Original Research

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