Mean Retrograde Leak Point Pressure Research Articles

Short-term evaluation of the adjustable bulbourethral male sling for post-prostatectomy urinary incontinence.

The Argus perineal sling is a minimally invasive surgical option to treat post-prostatectomy stress urinary incontinence (PPSUI). This study retrospectively evaluated the short-term clinical outcomes with the Argus sling for PPSUI management and determined the effects of potential preoperative parameters on intraoperative retrograde leak point pressure (RLPP). In this retrospective review of 16 men with various degrees of stress incontinence after prostatic surgery who underwent Argus sling, PPSUI was evaluated by pad usage, urodynamics, 24-hour pad weight, and validated questionnaires. Findings before and a minimum of 6 months after sling placement were compared. "Cure" was defined as no pad usage or the use of 1 pad for security; "improvement" was defined as a reduction in daily pad use by >50%. After a mean (±SD) follow-up of 9.75 ± 3.51 months, 62.5% of patients were cured, 18.75% were improved, and 18.75% were still incontinent. Preoperative 24-hour pad weight was positively correlated with RLPP (P = .0121, r = 0.6286). Mean RLPP was 37.93 ± 3.45 cmH2 O. During follow-up, 44% of men had transient perineal or scrotal pain managed conservatively. Sling explantation, reported in 3 of 16 patients, was associated with urethral erosion or previous radiation therapy. The Argus male sling can lead to satisfactory results in carefully selected patients. Increased stress urinary incontinence severity based on 24-hour pad weight required higher RLPP to achieve continence. Favorable satisfaction variables and quality of life scores are affected by appropriate intraoperative tensioning pressure.

Intraoperative Retrograde Perfusion Sphincterometry to Evaluate Efficacy of Autologous Vas Deferens 6-Branch Suburethral Sling to Properly Restore Sphincteric Apparatus During Robot-Assisted Radical Prostatectomy.

The aim of this study is to describe (urodynamically) the effect of the use of a 6-branch autologous suburethral sling, made with absorbable sutures and vas deferens, to support the bladder neck and urethra during robot-assisted laparoscopic prostatectomy (RALP) to improve early urinary continence (EUC) recovery. Retrograde leak point pressure (RLPP) was intraoperatively evaluated, by means of retrograde perfusion sphincterometry (RPS), in 77 patients (mean age ± standard deviation [SD]: 65.64 ± 7.23 years, mean body mass index ± SD: 26.69 ± 3.89) scheduled to undergo RALP at our institution. RLPP was evaluated before (RLPPb) and after pneumoperitoneum induction (RLPPp). RLPP was then evaluated after urethrovesical anastomosis (RLPPa) and after proper sling tensioning (RLPPs), with the aim to obtain the same pressure as after pneumoperitoneum induction. EUC recovery, defined as the use of no pad, was assessed 10 days, 30 days, and 6 months after catheter removal. RPS and proper autologous 6-branch sling positioning were feasible in all patients, without perioperative complications and negligible impact on overall operative time. Pneumoperitoneum induction increased, similarly, RLPP in all patients. An important decrease of sphincteric capability was evident after prostate removal and the following urethrovesical anastomosis, while proper sling tensioning allowed for restoration of sphincteric apparatus capability to its presurgical status (mean RLPPs 40.84 cmH2O vs RLPPp 40.39 cmH2O, p = 0.942). EUC recovery within 10 days after catheter removal was achieved in 59 (77%) patients and progressively improved over time. RPS, intraoperatively performed during RALP, allows for precise evaluation of the impact of the surgical procedure on sphincteric apparatus competence. Moreover, the use of the 6-branch suburethral sling, in association with RPS, allows for restoration of the proper supporting system to the urethral sphincter, similar to the preoperative condition, offering the basis for EUC recovery after radical prostate surgery.

The correlation between retrograde leak point pressure and 24-hour pad weight.

To assess the correlation between retrograde leak point pressure (RLPP) and 24-hr pad weight (24PW) in men with post-prostatectomy incontinence. We performed RLPP and 24PW measurements on 61 patients with a history of post-prostatectomy stress urinary incontinence (SUI). We examined the relationship of RLPP and 24PW. We also reviewed the urodynamic and clinical data of these patients to explain our findings. The mean age was 70 years (SD ± 7.4, range: 51-87). The mean RLPP was 36.8 cmH2 O (SD ± 15.3, range: 9-76), the mean 24PW was 499 g (±677 g, range: 16.5-3,177 g). There was a good and significant negative correlation between RLPP and 24PW (r = 0.56, P < 0.01). RLPP was able to differentiate between cases of mild/moderate (<400 g) and severe (≥400 g) incontinence. Patients with RLPP <30 cmH2 O had significantly higher 24PW (mean 825 g, median 768 g) when compared with patients with RLPP >30 cmH2 O (mean 257.8 g, median 100 g, P < 0.01). RLPP could be used as an objective and potentially more reliable substitute to pad weight to objectify and stratify SUI in post-prostatectomy patients. Neurourol. Urodynam. 36:1119-1123, 2017. © 2016 Wiley Periodicals, Inc.

PD01-02 THE CORRELATION BETWEEN RETROGRADE LEAK POINT PRESSURE AND 24-HOUR PAD WEIGHT FOR MEN WITH POST PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2016PD01-02 THE CORRELATION BETWEEN RETROGRADE LEAK POINT PRESSURE AND 24-HOUR PAD WEIGHT FOR MEN WITH POST PROSTATECTOMY INCONTINENCE Eskinder Solomon, Sachin Malde, Mahreen Pakzad, Rizwan Hamid, Julian Shah, Tamsin Greenwell, and Jeremy Ockrim Eskinder SolomonEskinder Solomon More articles by this author , Sachin MaldeSachin Malde More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Julian ShahJulian Shah More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2022AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the correlation between retrograde leak point pressure (RLPP) and 24-hour pad weight (24PW) in men with post prostatectomy incontinence METHODS We performed RLPP and 24PW measurements on 61 patients with post-prostatectomy stress urinary incontinence (SUI). We examined the relationship of RLPP and 24PW. We also reviewed the urodynamic and clinical data of these patients to explain our findings. RESULTS The mean age was 69.5 years (SD + 7.4, range: 51-87). The mean RLPP was 36.8 cmH2O (SD +/- 15.3, range: 9-76), the mean 24h pad-weight was 499g (+ 677g, range: 16.5g-3177g). There was a strong and significant negative correlation between RLPP and 24h pad-weight (r=0.56, p<0.0001). RLPP was a strong predictor of cases of mild/moderate (<400g) and severe (>400g) incontinence (Figure 1). Patients with RLPP = 30 had significantly higher 24h pad weight (mean 825g, median 768g) when compared with patients with RLPP > 30 (mean 257.8g, median 100g), p < 0.0001. Figure 1: Boxplot showing that patients with severe incontinence had statistically significantly lower RLPP than patient with mild or moderate incontinence CONCLUSIONS There is a good correlation between RLPP and 24PW. RLPP can distinguish between mild/moderate and severe levels of incontinence. RLPP could be used as an objective and more reliable substitute to pad weight to objectify and stratify SUI in post-prostatectomy patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e45-e46 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eskinder Solomon More articles by this author Sachin Malde More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Julian Shah More articles by this author Tamsin Greenwell More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does Use of a Second Cuff Improve Artificial Urinary Sphincter Effectiveness? Evaluation Using a Comparative Cadaver Model

The artificial urinary sphincter is the gold standard long-term solution for male stress incontinence. Some urologists believe that including a second urethral cuff at the time of placement can improve efficacy but strong evidence is lacking. We compared the functionality of a single vs a tandem cuff in a cadaver model. Artificial urinary sphincter reservoir pressure was confirmed at 61 to 70 cm H2O. The bulbar urethra was dissected through a perineal approach in each of 4 cadavers. Distal and proximal bulbar urethral circumference was measured. The membranous urethra was transected. Cuffs sized based on circumference measurements were placed distal and proximal, and connected to the reservoir and pump. Retrograde leak point pressure was measured sequentially across the distal, proximal and tandem cuffs. We used the Friedman test to compare retrograde leak point pressure among the 3 cuff positions, the paired t-test to compare distal and proximal urethral circumferences and the Spearman correlation to compare urethral circumference to retrograde leak point pressure. Mean retrograde leak point pressure across the distal, proximal and tandem cuffs was 73.5, 77.75 and 79.25 cm H2O, respectively (p=0.44). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm, respectively (p=0.019). There was a strong positive correlation between urethral circumference and retrograde leak point pressure (rs=0.5). The tandem cuff did not improve retrograde leak point pressure. Proximal bulbar urethral circumference was greater than distal circumference and increasing urethral circumference correlated with increasing retrograde leak point pressure. Therefore, the perceived benefit of tandem cuffs may reflect more proximal placement of one of the cuffs.

MP88-18 DOES USE OF A SECOND CUFF IMPROVE ARTIFICIAL SPHINCTER EFFECTIVENESS? EVALUATION USING A COMPARATIVE CADAVER MODEL

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-18 DOES USE OF A SECOND CUFF IMPROVE ARTIFICIAL SPHINCTER EFFECTIVENESS? EVALUATION USING A COMPARATIVE CADAVER MODEL Madeleine Manka and E. James Wright Madeleine MankaMadeleine Manka More articles by this author and E. James WrightE. James Wright More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The artificial urinary sphincter (AUS) has long been recognized as the most effective long-term solution for men with severe stress incontinence. It is widely believed that inserting a second (tandem) urethral cuff can improve device efficacy, but this supposition is backed by little empirical evidence. In this study, we directly compare the functionality of a single versus tandem cuff in a cadaver model. METHODS The AUS reservoir pressure was confirmed to be between 61-70 cm H2O via burette test. The bulbar urethra was dissected using a perineal approach in each cadaver (n=4). The resting urethral circumference of the distal and proximal bulbar urethra was measured. The membranous urethra was transected. Appropriately sized occlusive cuffs were placed in the distal and proximal positions and connected to the pressure reservoir and control pump. Retrograde leak point pressure (RLPP) was measured sequentially across the distally placed single cuff, the proximally placed single cuff, and two tandem cuffs by inserting a catheter in the occluded urethra and raising an attached bag of fluid until leakage was seen across the transected urethra. The height between the fluid and cuff was recorded (cm H2O). A Friedman test was used to compare RLPP between the three cuff configurations, a paired t test to compare distal and proximal urethral circumference, and a Pearson correlation to compare urethral circumference to RLPP. RESULTS Mean RLPP across the distal, proximal and tandem cuffs was 70.25, 77.75, and 76.75 cm H2O respectively (p=0.14). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm respectively (p =0.019). There was a strong positive correlation between urethral circumference and RLPP (r = 0.75). CONCLUSIONS The tandem cuff does not appear to improve leak point pressure. In addition, the proximal bulbar urethral circumference (below the crus) was found to be significantly greater than the distal urethral circumference. Increasing urethral circumference was strongly correlated with an increase in the pressure needed to overcome cuff occlusion (RLPP). Therefore, it would appear that the perceived benefit of a second urethral cuff reflects function of the more proximal cuff alone. In our model, a tandem cuff did not increase effectiveness of the AUS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1098-e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeleine Manka More articles by this author E. James Wright More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retrograde leak point pressure correlates with 24 h pad weight for assessing post prostatectomy incontinence

Retrograde leak point pressure correlates with 24 h pad weight for assessing post prostatectomy incontinence

Chronic sacral nerve stimulation as a novel treatment for stress urinary incontinence-A rat model

We propose an animal model to evaluate the effect of chronic sacral nerve stimulation (SNS) on surgically induced intrinsic sphincter deficiency (ISD) secondary to transabdominal urethrolysis (U-Lys). Twenty-five 6-week old virgin female Sprague-Dawley rats were divided into four groups: control (CTRL), U-Lys only, SNS only, and both (U-Lys/SNS). Groups CTRL (N = 5) and U-Lys only (N = 5) were maintained in the animal research facility in standard fashion for 2 weeks. Groups SNS only (N = 5) and U-Lys/SNS (N = 10) underwent chronic SNS for 6 continuous hours daily for 2 weeks. Retrograde leak point pressure (RLPP) was measured at baseline and at 2 weeks following observation or treatment. Five consecutive RLPP measurements were averaged per measurement cycle. SAS 9.3 was used to evaluate means and standard deviation. Baseline mean RLPP was 65 mmHg. The U-Lys only group mean RLPP at initial urethrolysis (58 mmHg) decreased (31 mmHg, P < 0.0001) after 2 weeks of observation. In the SNS only group, mean RLPP significantly increased from baseline (73 mmHg) after 2 weeks of chronic SNS stimulation (80 mmHg, P < 0.01). In rats that underwent both U-Lys and SNS stimulation mean RLPP was initially low (46 mmHg) after U-Lys and then significantly increased after 2 weeks of SNS (65 mmHg, P < 0.0001). Chronic SNS mediates an improvement in urethral sphincteric function at stimulation parameters similar to those used in humans for treating voiding dysfunction. SNS increased urethral resistance in rats with and without surgically induced ISD.

Anatomical and Manometric Comparison of Perineal and Transscrotal Approaches to Artificial Urinary Sphincter Placement

We compared cuff sites and assessed anatomical and manometric differences between the transscrotal and perineal approaches to artificial urinary sphincter placement in fresh male cadavers. Artificial urinary sphincter implantation using perineal and transscrotal incisions was performed in 15 fresh male cadavers. The artificial urinary sphincter cuffs were placed as proximal as possible using each approach. After measuring urethral circumference at each cuff site, an appropriately sized cuff was placed at each location. The 61 to 70 cm H(2)O pressure reservoir and control pump were then connected to the cuffs. Retrograde leak point pressure was assessed sequentially across each cuff. The paired t test was used to compare urethral circumference and retrograde leak point pressure between the 2 approaches. Mean urethral circumference using the perineal and transscrotal approaches was 5.38 (range 3.2 to 7.5) and 3.81 cm (range 3 to 4.5), respectively (p <0.0001, 95% CI of difference 0.99-2.13). Mean retrograde leak point pressure using the perineal and transscrotal approaches was 90.1 and 64.9 cm H(2)O, respectively (p = 0.0002, 95% CI of difference 13.7-33.5). On visual inspection of cuff sites, the perineal approach was more proximal on the urethra than the transscrotal approach. While the transscrotal approach to artificial urinary sphincter placement has the advantage of technical ease, the anatomical and manometric findings of this cadaver study suggest that the perineal approach offers a more proximal cuff location, more robust urethral size and more effective urethral coaptation than the transscrotal approach.

519 CORRELATION OF RETROGRADE LEAK POINT PRESSURE WITH OBJECTIVE SEVERITY OF INCONTINENCE AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy I1 Apr 2012519 CORRELATION OF RETROGRADE LEAK POINT PRESSURE WITH OBJECTIVE SEVERITY OF INCONTINENCE AFTER RADICAL PROSTATECTOMY Ingrid Schauer, Erik Randall Huber, Michael Rutkowski, Peter Birner, and Wilhelm Alexander Hübner Ingrid SchauerIngrid Schauer Krems, Austria More articles by this author , Erik Randall HuberErik Randall Huber Korneuburg, Austria More articles by this author , Michael RutkowskiMichael Rutkowski Korneuburg, Austria More articles by this author , Peter BirnerPeter Birner Vienna, Austria More articles by this author , and Wilhelm Alexander HübnerWilhelm Alexander Hübner Korneuburg, Austria More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.591AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As variable treatment options are required for different grades of post-prostatectomy stress urinary incontinence (SUI) an evaluation of patients before incontinence correction surgery is necessary. The objective of this study was to determine if the retrograde leak point pressure (RLPP) correlates with the severity of incontinence in patients after radical prostatectomy (RPE). METHODS 12 patients suffering from post-prostatectomy SUI, admitted for incontinence correction surgery, were evaluated by RLPP, 24h micturition protocol, pad count, 20-minute pad-test and 24h pad-weight. RLPP was measured by retrograde infusion of the urethra using a tip hole catheter, which was blocked in the navicular fossa. The relationship between the parameters was examined with Pearson correlation. RESULTS The patients' mean age was 68 years (SD +/− 6.5, range: 54-77), the mean RLPP was 34.3 cmH2O (SD +/− 10.4 cmH2O), the mean 20-minute pad-test was 23.8g (SD +/− 38.0g) and the mean 24h pad-weight was 275.3g (SD +/− 333.0g). No significant correlation could be found between 24h pad-weight and 20-minute pad-test or pad count (r=0.06, p=0.91 and r=0.31, p=0.51, respectively). There was a strong and significant negative correlation between RLPP and 24h pad-weight (r=-0.87, p=0.025). CONCLUSIONS Currently the 24h pad-weight constitutes the gold standard in evaluation of urinary incontinence. Nevertheless, it is time-consuming and depends on the compliance of the patient. Neither the 20-minute pad-test nor the pad count showed a significant correlation with 24h pad-weight; therefore seem to be of questionable value in evaluation of incontinence. In contrast the RLPP demonstrates a strong and significant negative correlation with 24h pad-weight, thus it could be used as a standardized and practicable parameter to objectify SUI in post-prostatectomy patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e213 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ingrid Schauer Krems, Austria More articles by this author Erik Randall Huber Korneuburg, Austria More articles by this author Michael Rutkowski Korneuburg, Austria More articles by this author Peter Birner Vienna, Austria More articles by this author Wilhelm Alexander Hübner Korneuburg, Austria More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A New Quadratic Sling for Male Stress Incontinence: Retrograde Leak Point Pressure as a Measure of Urethral Resistance

Objective methods are essential for evaluating post-prostatectomy incontinence. While symptom score and pad weight may be the most useful methods to evaluate preoperative vs postoperative continence, neither is useful for guiding intraoperative sling tension. The Virtue quadratic sling (Coloplast, Humlebaek, Denmark) is a new device for treating post-prostatectomy incontinence that combines a transobturator and prepubic surgical approach. We examined urethral resistance by measuring retrograde leak point pressure during key portions of the surgery. A total of 22 consecutive men who elected to undergo Virtue sling surgery were evaluated with retrograde leak point pressure before and during the surgery. Retrograde leak point pressure was measured via perfusion sphincterometry at baseline, after transobturator tensioning, after prepubic tensioning, and after transobturator and prepubic arms were secured in place. Mean patient age was 70 years. Mean baseline retrograde leak point pressure was 33.4 ± 8.8 cm water. After transobturator tensioning, mean retrograde leak point pressure increased to 43.3 ± 6.8 cm water. After prepubic tensioning mean retrograde leak point pressure was 55.8 ± 8.7, and final retrograde leak point pressure after transobturator and prepubic fixation increased to 68.8 ± 6.0 cm water. Each mean retrograde leak point pressure value was significantly higher than the preceding value. The Virtue sling provides ventral urethral elevation using a transobturator approach, and a long segment of urethral compression against the genitourinary diaphragm via a straightforward prepubic technique without the risks of bone screws or retropubic needle passage. Transobturator and prepubic components of the quadratic fixation contributed to increasing urethral resistance as measured by intraoperative retrograde leak point pressure. This quadratic technique has a potentially greater ability to provide urethral compression than does a purely perineal or transobturator sling.

COMPARISON OF PERINEAL AND PENOSCROTAL APPROACHES FOR ARTIFICIAL URINARY SPHINCTER PLACEMENT

La prostatectomie radicale a beaucoup évolué durant les 20 dernières années avec, d’une part, une connaissance approfondie de l’anatomie de la prostate, et d’autre part, l’avènement de nouvelles techniques de conservation des bandelettes neuro-vasculaires. Malgré ces progrès, le taux de dysfonction érectile post-prostatectomie varie entre 30 et 90 % selon les séries et c’est l’élément impactant la qualité de vie le plus souvent altérée après prostatectomie radicale. L’objectif de ce travail était d’effectuer une revue de la littérature évaluant les différents protocoles de rééducation érectile post-prostatectomie radicale.Une revue systématique de la littérature à partir de la base de recherche PubMed a été effectuée de 1995 à 2013 en utilisant les mots clés suivants : therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection.L’analyse critique des études sélectionnées met en évidence l’absence de protocole standard établi de rééducation érectile précoce post-prostatectomie radicale. Ces études ont démontré qu’une prise en charge précoce, par injections intra-caverneuses ou par IPDE5, améliorait la récupération des érections tel que le recommande l’Association française d’urologie.La prise en charge des troubles de la sexualité post-prostatectomie radicale est essentielle, elle doit s’organiser dans un protocole bien établi alliant l’aide pharmacologique et l’éducation thérapeutique délivrée par des praticiens ou des infirmières formées. Il serait nécessaire d’élaborer au sein d’un essai clinique un protocole standard de prise en charge.Radical prostatectomy has evolved considerably during the last 20 years, with one hand, a thorough knowledge of the anatomy of the prostate, and secondly, the introduction of new conservation techniques of neurovascular bundles. Despite this progress, the rate of post-prostatectomy erectile dysfunction varies between 30 and 90% depending on the series and this element impacts the quality of life after radical prostatectomy. The objective of this work was to conduct a review of the literature in order to evaluate the various protocols of post-radical prostatectomy erectile rehabilitation.A systematic review of the literature from the basic PubMed search was performed using the following keywords. Therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection.The critical analysis of selected studies highlights the lack of standard protocol that established erectile rehabilitation early after radical prostatectomy. These studies have shown that early treatment, injections or intracavernous PDE5 inhibitors improved recovery of erections as recommended by the French Association of Urology.Management of disorders of post-radical prostatectomy sexuality is essential, it must be organized in a well-established protocol combining pharmacological and therapeutic education assistances delivered by practitioners or nurses. It would need to develop in a clinical trial a standard protocol.

Is HCl Duloxetine Effective in the Management of Urinary Stress Incontinence after Radical Prostatectomy?

Introduction: Up to 70% of patients who undergo radical prostatectomy complain about urine leakage, but persistent stress incontinence 1 year after surgery affects <5% of them. HCl duloxetine is a dual serotonin and norepinephrine reuptake inhibitor that relieves the symptoms of stress urinary incontinence. The purpose of this study was to evaluate the efficacy of HCl duloxetine in the management of urinary incontinence after radical prostatectomy and its impact in urodynamic parameters such as maximal urethral closure pressure (MUCP), abdominal leak point pressure (ALPP) and retrograde leak point pressure (RLPP). Material and Methods: The study included 18 men with stress urinary incontinence 12 months after radical prostatectomy. All underwent a pad test to quantify the degree of urine loss and a urodynamic evaluation before and after a three month treatment with HCl duloxetine. The intrinsic sphincter was evaluated by ALPP and RLPP and the striated sphincter by MUCP. Results: At the pretreatment evaluation the mean ALPP was 52.1 cm H₂O, the mean MUCP was 52.5 cm H₂O and the mean RLPP was 43.1 cm H₂O. After 3 months of HCl duloxetine treatment the mean ALPP was 59.1 cm H₂O, the mean MUCP was 67.3 cm H₂O and the mean RLPP was 45.1 cm H₂O. There was a statistically significant correlation among RLPP, MUCP and ALPP before treatment. After HCl duloxetine treatment there was significant correlation between RLPP and ALPP. Conclusion: The use of HCl duloxetine results in mild increase of MUCP and in significant reduction of urine loss. Its action on the extrinsic sphincter does not provide a complete treatment option for postprostatectomy incontinence.

THE MALE SLING FOR STRESS URINARY INCONTINENCE: URODYNAMIC AND SUBJECTIVE ASSESSMENT

We prospectively examined whether the fixed urethral resistance of the perineal male sling for the treatment of stress incontinence causes significant bladder outlet obstruction or de novo voiding dysfunction. A total of 22 patients (average age 67 years old) were evaluated before and after surgery with videourodynamics, the self-administered UCLA Prostate Cancer Index incontinence section and pad score. Mean followup was 25 months (range 6 to 42). All patients complained of a moderate to severe problem before surgery. After surgery 16 (73%) reported a very small problem/no problem, 3 (14%) a moderate problem and 3 (14%) reported a big problem. Average pad use +/- SD decreased from 4.6 +/- 2.5 to 0.74 +/- 1.0 pads (p <0.01). Median UCLA Prostate Cancer Index incontinence score increased from 82 to 313, p <0.001. Mean retrograde leak point pressure (RLPP) increased from 30.4 +/- 15.9 to 59.9 +/- 9.7 cm water. Bladder outlet obstruction did not develop in any patients after surgery. Average maximum flow rate did not change significantly (17.7 +/- 6.5 vs 19.2 +/- 9.7 ml per second, p = 0.6). Nor was there a significant change in detrusor pressure at maximum flow rate (40.3 +/- 9.2 vs 45.8 +/- 14.7 cm water, p = 0.3). While de novo urgency or urge incontinence did not develop in any patients, 2 of 5 patients with a moderate/big leakage problem demonstrated postoperative detrusor overactivity on cystometry. Both individuals requiring more than 3 pads daily had a postoperative RLPP of less than 50 cm water. Pad use, leak point pressure and urinary incontinence scores are significantly improved after sling surgery. Fixed resistance does not lead to bladder outlet obstruction. Postoperative RLPP less than 50 cm water and urodynamic detrusor overactivity are associated with increased pad use and bother.

Correlation among maximal urethral closure pressure, retrograde leak point pressure, and abdominal leak point pressure in men with postprostatectomy stress incontinence

Objectives To assess the correlation among abdominal leak point pressure (ALPP), maximal urethral closure pressure (MUCP), and retrograde leak point pressure (RLPP) in the evaluation of men with stress urinary incontinence (SUI) after radical prostatectomy. Methods Patients were evaluated with a self-administered questionnaire regarding pad use and with multichannel videourodynamics. The ALPP, MUCP, and RLPP were compared with each other and with the severity of SUI. Results The mean ALPP was 49.4 ± 24.4 cm H 2O. The mean MUCP was 52.0 ± 21.1 cm H 2O. The mean RLPP was 48.0 ± 13.5 cm H 2O. No statistically significant difference in the mean values of the three parameters was found. Regression analysis revealed a statistically significant correlation among the three parameters: RLPP versus MUCP, r = 0.59, P <0.005; MUCP versus ALPP, r = 0.75, P <0.0001; and RLPP versus ALPP, r = 0.79, P <0.0001. ALPP, MUCP, and RLPP were each significantly related to pad use. Conclusions Intrinsic sphincter deficiency is the primary cause of SUI after radical prostatectomy. Therefore, evaluation of intrinsic sphincter function is important in the treatment of postprostatectomy SUI. In incontinent men after radical prostatectomy, with a dysfunctional bladder neck and proximal sphincter unit, the intrinsic function of this distal sphincter may be assessed equally well by evaluating the resistance to antegrade leakage, retrograde leakage, or profilometric measurement of the urethral closure pressure. RLPP and MUCP offer reliable alternatives to ALPP for the evaluation of postprostatectomy SUI.

Retrograde leak point pressure for evaluating postradical prostatectomy incontinence

Objectives To evaluate a technique of measuring the retrograde leak point pressure (RLPP) for assessing men with postradical prostatectomy stress urinary incontinence (SUI). Methods We measured RLPP in adult men by retrograde infusion of the distal urethra while simultaneously recording intraurethral pressure. The reproducibility of this test, and its dependence on urethral infusion rate, bladder volume, and anterior urethral catheter position, were evaluated. RLPP and abdominal leak point pressure (ALPP) measurements were performed in postradical prostatectomy patients. RLPP was com- pared with ALPP and with severity of incontinence determined by pad usage. Results Repeated RLPP measurements were not significantly different and did not change with bladder volume up to half capacity or with the location of the catheter in the anterior urethra. The differences between RLPP measurements with infusion rates of 2, 4, and 8 mL/min were also not significant. Twenty-seven men were evaluated 6 to 108 months after surgery. Of these, 22 (81%) demonstrated SUI. Mean RLPP in men without SUI (79.2 ± 14 cm H 2O) was significantly higher than in men with SUI (51.9 ± 13 cm H 2O, P < 0.01 ). In men with SUI, ALPP and RLPP were significantly correlated, and ALPP (49.8 ± 24 cm H 2O) was not significantly different from RLPP (51.9 ± 13 cm H 2O). Pad use and RLPP were also significantly related. Conclusions RLPP measurements are reproducible and simple to perform. The pressure at which leakage occurs is easily identifiable as the plateau pressure. RLPP correlates significantly with the lowest of multiple ALPP measurements in men with SUI. This technique represents a reliable urodynamic alternative for eval- uating men with postradical prostatectomy SUI.