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Post-prostatectomy Incontinence (Evaluation and Practical Urodynamics)
Book chapter

Post-prostatectomy Incontinence (Evaluation and Practical Urodynamics)

H. Henry Lai and Timothy B. Boone
Advanced Male Urethral and Genital Reconstructive Surgery, pp.721-732
Current Clinical Urology, Springer, Second edition
2014
DOI: 10.1007/978-1-4614-7708-2_50

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Abstract

Post-prostatectomy incontinence (PPI) may be caused by intrinsic sphincteric deficiency (ISD) resulting in stress urinary incontinence (SUI), or bladder dysfunction (e.g., detrusor overactivity resulting in urgency incontinence, loss of detrusor compliance, or detrusor underactivity resulting in retention and overflow incontinence). Many PPI patients have concomitant sphincteric and bladder dysfunction. Most PPI patients have ISD secondary to sphincteric damage thought to arise from nerve or vascular damage to the distal urethral sphincteric complex. Detrusor factors contributing to incontinence are common, though rarely the sole cause. Conservative management such as pelvic floor exercises or anticholinergic medications may commence early after surgery with minimal workup. However, if bothersome PPI persists 6–12 months after prostatectomy, additional evaluation such as urodynamic testing should be considered, so a rational management plan can be formulated. This is particularly important if surgical treatment is contemplated. This chapter will examine the evaluation and urodynamic testing for post-prostatectomy urinary incontinence.
 Detrusor Overactivity Intrinsic Sphincteric Deficiency Stress Urinary Incontinence Urethral Stricture Urgency Incontinence

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