Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinence

Abstract

Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure profile was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three different pressure components were defined in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H(2)O in five cases of severe incontinence. No significant difference was observed for these patients on urethral profile components 6 months later. In contrast, in cases of significant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence.

Urethral sphincter function before and after radical prostatectomy: Systematic review of the prognostic value of various assessment techniques

“…Several studies performed UPP before and after RRP (Table I). Most of the studies show a significant decrease of the functional urethral length after RRP 13–18. In these studies mean FPL at baseline was 5.0 cm (range 4.3–6.1 cm).…”

“…1). Articles on the following assessment techniques were found and discussed separately: sphincter electromyography (two studies),4, 5 MRI (six studies),6–11 urethral pressure profilometry (UPP) (10 studies),12–21 and perfusion sphincterometry (seven studies) 22–28. Only techniques described by two or more studies were included.…”

An adjustable continence therapy device for treating incontinence after prostatectomy: a minimum 2‐year follow‐up

“…Incontinence after prostatectomy due to sphincteric weakness can significantly compromise the quality of life (QoL) of affected patients [1–4]. The current standard for the surgical treatment of this condition is placing an artificial urinary sphincter (AUS) which, despite confirmed efficacy, still has ongoing concerns about cost, device infection, durability, mechanical failure and urethral erosion [5–7].…”

Post-Prostatectomy Voiding Dysfunction

“…When SUI is present postoperatively, it represents insufficiency of the intrinsic component responsible for passive continence and/or dysfunction of the extrinsic component responsible for active continence [4]. Thus, a patient may present with paradoxical passive incontinence (ISD) despite a high voluntary urethral pressure (extrinsic sphincter function).…”