Post-prostatectomy incontinence: Urodynamic findings and treatment outcomes

Purpose: We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence. Materials and Methods: A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocative multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment. Results: Based on the results of urodynamic studies 40% of the men had genuine stress incontinence alone and approximately 60% had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p <0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement. Conclusions: In our large series most men with post-prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define the cause of incontinence but to direct effective therapy.