The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence

Abstract

Prostate cancer is a common male malignancy. Radical prostatectomy is a common treatment option in patients with localised disease. Post-prostatectomy incontinence (PPI) is not uncommon, with a significant impact on the quality of life. However, it is often under-reported and undertreated. There are no standard international guidelines specifically for investigation and diagnosis of PPI. The routine use of urodynamic studies (UDS), with an attempt to assess urinary incontinence aetiology and to predict success prior to invasive surgical treatment, has been widely adopted but remains controversial. Literature concerning the pros and cons of pre-operative UDS is reviewed. There are conflicting results on UDS findings post-prostatectomy. Few studies demonstrated that UDS findings are not predictive of outcomes of the artificial urinary sphincter (AUS). Other studies have shown the presence of detrusor overactivity (DO) to be an adverse prognostic factor, especially for PPI patients treated with male sling success. Currently, there is no consensus on the indication for UDS in patients with PPI. Despite conflicting results on the usefulness of UDS prior to PPI surgery, the majority of surgeons still routinely perform UDS pre-operatively. Further prospective and randomised controlled studies would be beneficial in determining if routine UDS is required before surgical treatment for PPI. The authors also gave their perspective on the application of personalised UDS in investigating patients PPI prior to treatment.