You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112167 MAXIMUM ISOMETRIC DETRUSOR CONTRACTION IN MEN WITH POST-PROSTATECTOMY INCONTINENCE Christopher Elliott and Craig Comiter Christopher ElliottChristopher Elliott Stanford, CA More articles by this author and Craig ComiterCraig Comiter Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2404AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor dysfunction in the form of poor contractility has been reported in up to 40% of men following radical prostatectomy, regardless of continence status. However, “true” detrusor contraction strengths have not been measured in these studies. Rather surrogates such as the presence of Valsalva voiding, low detrusor pressures at maximum flow (PdetQmax) or the use of bladder contractility nomograms developed for men with intact prostates have been used. To date the use of isovolumetric contraction pressure (Piso) to measure bladder contractility has not been reported in this population. We present our experience in men with post-prostatectomy incontinence (PPI). METHODS We performed a retrospective review of all men referred to our institution in the last 3 years for PPI evaluation. All men undergoing urodynamic examination during this time (62 of 65) were included for study. Videourodynamic evaluation was performed with a standard seven French urodynamic catheter using concomitant rectal pressure monitoring. A maximum isometric detrusor contraction measurement was obtained using the continuous occlusion test (COT). Statistical analysis was performed using Mann-Whitney and linear regression tests to evaluate the effect of patient variables on Piso. RESULTS Piso was measurable in 60 men with a median value of 60cmH2O (range 0–110). Piso was < 50 cm water in 24/60 (40%). Isometric contractility was higher in men with urodynamic evidence of detrusor overactivity (71.5 vs 47 cm water, p=.010) and in non-Valsalva voiders compared to Valsalva voiders (60 vs 24 cm water, p=.016). Piso was also positively correlated with PdetQmax (p<.001) and detrusor reserve (p<.001); it was negatively correlated with bladder compliance (p=.010). Isometric contraction strength was unrelated to age, time since radical prostatectomy, leak point pressure, pad use, history of pelvic radiation, maximum urinary flow rate or bladder capacity (p>.05 for all). CONCLUSIONS Our data suggest that detrusor contraction strength can be easily measured by the COT in men with PPI. Indeed, 40% of men demonstrated a Piso < 50 cm water. As low contractility is a relative contraindication to sling surgery, bladder contractility should be measured in men prior to incontinence surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e867-e868 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Elliott Stanford, CA More articles by this author Craig Comiter Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...