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

Chung, Doreen E.; Dillon, Benjamin; Kurta, Jordan M.; Maschino, Alexandra C.; Cronin, Angel M.; Sandhu, Jaspreet S.

doi:10.5489/cuaj.11038

Cited by 18 publications

(20 citation statements)

References 29 publications

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“…Another objective of this study was to evaluate the relative rates of DU in these 2 groups, as previous studies have shown a higher incidence of DU in patients who had undergone a minimally invasive procedure [11]. Contrary to the work by Chung et al, our data did not show increased rates of DU in patients following DVP compared to men who had undergone an open procedure.…”

Section: Methodscontrasting

confidence: 81%

“…These urodynamic findings include an increase in the incidence of ISD, a decrease in cystometric capacity and bladder compliance, and an increase in both detrusor overactivity and detrusor under activity [5][6][7][8][9][10][11]. Some of these variables have been shown to improve with time, but even 3 years following prostatectomy, they may not parameters in patients who underwent radical retropubic (RRP) versus minimally invasive prostatectomy is not nearly as well reported.…”

Section: Discussionmentioning

confidence: 85%

“…Detrusor overactivity is defined as any uninhibited/ inappropriate detrusor contraction during filling. Detrusor underactivity is defined as those patients with a Qmax < 15 ml/ sec and a PdetQmax < 20 cm H 2 O as previously described [11].…”

Section: Methodsmentioning

confidence: 99%

“…More recently, detrusor underactivity (DU), or hypocontractility, has been reported on urodynamics in a number of patients following radical prostatectomy [11,6,9]. Damage to nerves innervating the bladder during prostatectomy has been suggested as a factor contributing to the decrease in contractility.…”

Section: Introductionmentioning

confidence: 97%

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Urodynamic Findings in Men Presenting with Incontinence After Open Versus Robotic Radical Prostatectomy

Henderson¹,

Zuckerman²,

McCammon³

2013

UIJ

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Introduction:Urodynamic findings in patients with post-prostatectomy incontinence (PPI) following either an open radial retropubic prostatectomy or a robotic-assisted laparoscopic prostatectomy are not well described. Methods: After IRB approval, we performed a retrospective review of urodynamic findings in patients presenting to our institution with PPI following either an open or robotic prostatectomy from 1985 through 2009. results: One hundred and twenty-six patients were identified for analysis (74 robotic, 52 open). Intrinsic sphincter deficiency was the cause of PPI in the majority of patients in both groups. Detrusor pressure at peak flow was significantly higher, and peak flow rate was significantly lower in patients who had undergone an open procedure. Anastomotic stenosis (AS) was also higher following an open procedure. Detrusor over-and underactivity were similar between the groups. conclusions: Following an open compared to a robotic prostatectomy, patients experienced elevated voiding pressures and decreased peak flows, presumably secondary to the increased incidence of AS observed in those patients.

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Section: Methodscontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Urodynamic Findings in Men Presenting with Incontinence After Open Versus Robotic Radical Prostatectomy

Henderson¹,

Zuckerman²,

McCammon³

2013

UIJ

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“…1 We agree with the authors that bladder strength has implications for the treatment of post-prostatectomy stress incontinence, because putting a compressive sling in a man with detrusor underactivity could lead to urinary retention. However, we question whether the criteria they used to identify detrusor underactivity is appropriate in men after radical prostatectomy.…”

mentioning

confidence: 45%

Measuring bladder strength: Letter

Elliott

Comiter

2013

CUAJ

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C hung and colleagues tackle the important issue of assessing bladder strength in men with voiding complaints after radical prostatectomy. 1 We agree with the authors that bladder strength has implications for the treatment of post-prostatectomy stress incontinence, because putting a compressive sling in a man with detrusor underactivity could lead to urinary retention. However, we question whether the criteria they used to identify detrusor underactivity is appropriate in men after radical prostatectomy.The authors report that 41% of the 264 men who underwent urodynamic study had detrusor underactivity, which they defined as a maximum flow rate (Qmax) less than 15 mL/sec and a detrusor pressure at maximum flow (PdetQmax) less than 20 cmH2O during voiding. These criteria are a derivation of the Bladder Contractility Index (BCI) (5*Qmax + PdetQmax, where an index less than 100 is considered weak). Both the BCI and its derivations have been used in most other studies of bladder strength in men following radical prostatectomy.However, the BCI was developed for men with benign prostatic hyperplasia.2 Its use in men after the prostate is removed has not been validated. In fact, for women (who have no prostate and may more closely mirror the postprostatectomy population in terms of voiding dynamics) the BCI and basic pressure flow tests are considered inaccurate for measuring bladder strength.3 Similarly, in men who lack normal prostatic resistance, the contractile pressure required to maintain axial flow can approach zero.The results published by Han and colleagues similarly illustrate the potential inappropriateness of using BCIdetermined bladder strength to guide treatment of postprostatectomy stress incontinence. 4 They reported that in 50 men with weak bladder strength (as measured with the BCI), there was no increase in urinary retention after the placement of male slings. They further showed that a man's use of Valsalva to aid in voiding did not predict urinary retention either.Perhaps, we need to focus on identifying more suitable measures of bladder strength (i.e., Watts factor, isometric detrusor pressure) in this population if we are to improve our understanding of post-prostatectomy voiding dynamics and identify true risk factors for urinary retention after male sling placement. Only then will we be able to appropriately counsel patients on their options for stress incontinence treatment.

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Retracted: Prelamin A overexpression promotes detrusor calcification/aging in urinary incontinence via prelamin A accumulation

Guan

Luo

et al. 2019

Journal Cellular Physiology

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Urinary incontinence (UI) is known as a distressing condition particularly among older adults, and negatively associated with health‐related quality of life in both males and females. Prelamin A accumulation has been found in all progeroid laminopathies and is obviously linked to cell and organism aging. Therefore, this study was expected to investigate the effect of prelamin A on detrusor on UI. Prelamin A expression in clinical and animal samples was detected. To investigate the degree of prelamin A accumulation and detrusor calcification/aging, the detrusor cells were subcultured separately into low and high passage. The low‐passage subculture cells were treated with transfection of overexpressed prelamin A plasmid, and transfection of overexpressed prelamin A plasmid and application of farnesyl transferase inhibitor (FTIs) H‐9279, respectively. Zmpste24, Icmt and lamin A/C expression were detected to explore how prelamin A affected detrusor calcification/aging. Prelamin A was overexpressed in aged detrusor cells, indicating prelamin A expression was positively related to the age of subjects. The degree of prelamin A accumulation and detrusor calcification/aging was higher in aged rats and high passage subculture cells. Zmpste24, Icmt and lamin A/C were poorly expressed in cells transfected with overexpressed prelamin A, as well as cell proliferation activity decreased and calcium deposition and apoptotic rate increased. Furthermore, we also found that the effect of overexpressed prelamin A was lost when cells were treated with H‐9279. These findings provide evidence that prelamin A overexpression impairs degradation of its farnesylated form, thus causing prelamin A accumulation which induces detrusor calcification/aging in UI.

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

Cited by 18 publications

References 29 publications

Urodynamic Findings in Men Presenting with Incontinence After Open Versus Robotic Radical Prostatectomy

Urodynamic Findings in Men Presenting with Incontinence After Open Versus Robotic Radical Prostatectomy

Measuring bladder strength: Letter

Retracted: Prelamin A overexpression promotes detrusor calcification/aging in urinary incontinence via prelamin A accumulation

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