Abstract
The reported incidence of urinary incontinence (UI) due to bladder dysfunction following surgery of BPH is variable. We described the causes of incontinence in a large group of men that developed this unusual complication and analyzed the influence of age on the prevalence of bladder dysfunction. We evaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH: Transurethral resection of the prostate (81 men) and open prostatectomy (44 men). A third group of 21 patients with incontinence following radical prostatectomy was used for comparison. All patients underwent urodynamic analysis. Urethral Sphincter Insufficiency (USI) was defined as involuntary loss of urine induced by Valsalva maneuver in the absence of a detrusor contraction. Bladder dysfunction was defined as detrusor overactivity and/or decreased compliance. Urethral sphincter insufficiency was the most common etiology of urinary incontinence in the three groups of patients. However, bladder dysfunction was observed in 59.3%, 56.8% and 57.1% of patients who underwent transurethral resection, open prostatectomy and radical prostatectomy, respectively. Median patient age was 69 and 75 years for patients with and without bladder dysfunction, respectively. A logistic regression model for the presence of bladder dysfunction showed that age was a statistically significant predictor. Urethral Sphincter insufficiency is the main cause of incontinence following surgery for BPH. Bladder dysfunction may be the isolated cause of incontinence in approximately 25% of patients. The chances of bladder dysfunction rises 5.3% for each year added to patient age. Patients older than 70 years have twice the probability of post procedural incontinence.
Highlights
BPH is the most common benign neoplasm in men [1] and contemporary data shows that about 10% of these patients will need some form of surgical treatment [2]
Due to the inconsistent reports linking Bladder dysfunction (BD) to post-prostatectomy incontinence, [7,8,9] and the impact of BD on the outcome of treatment, we reported the causes of urinary incontinence (UI) in a relatively large group of men with this rare complication following surgery for BPH and compared them to a group of patients with UI following RP
Decreased compliance (DC) was the sole cause of incontinence in 13 patients (8.9%) and occurred in combination with SUI in 30 patients (20.5%)
Summary
BPH is the most common benign neoplasm in men [1] and contemporary data shows that about 10% of these patients will need some form of surgical treatment [2]. UI following surgery for BPH is a rare complication. While early incontinence may occur in up to 30-40% of patients, late incontinence occurs in fewer than 1% of cases [3,4]. The etiology of post-prostatectomy incontinence can be multifactorial, including USI and/. USI occurs as a result of injury to the sphincter mechanism and incontinence is usually associated with increase in. BD, which includes detrusor overactivity and/or DC. DC is associated with increase in detrusor pressure with storage of urine, which can result in urinary incontinence
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