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Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency.
Eur Urol. 2007 Jul; 52(1):38-45.EU

Abstract

OBJECTIVES

To analyse the relationship between RRP and urodynamic bladder dysfunction, and compare preoperative and postoperative functional status over long-term follow-up. Hypothesis on the pathophysiologic mechanism underlying urodynamic dysfunction has been reported.

METHODS

PubMed databank search for original articles followed by review of urodynamic parameters: bladder filling sensation, detrusor overactivity, bladder compliance, cystometric bladder capacity, impaired detrusor contractility, bladder outlet obstruction, urinary incontinence.

RESULTS

Detrusor dysfunction was rarely present as the sole diagnosis and was usually coupled with intrinsic sphincter deficiency. Data on bladder filling sensation, cystometric capacity, detrusor overactivity, impaired detrusor contractility, and bladder outlet obstruction were limited and contradictory. Detrusor overactivity was a de novo dysfunction in 2%-77% of patients. Impaired bladder compliance was present in 8%-39% of patients and was de novo in about 50%. Impaired detrusor contractility was found in 29%-61% of patients, was de novo in 47%, and recovered in about 50% of patients. The role of these dysfunctions as etiologic agents of urinary incontinence or voiding symptoms was unevenly assessed.

CONCLUSIONS

Postoperative decentralization of the bladder, inflammation and/or infection, and geometric bladder wall alteration associated with preexisting hypoxemia with/without neuroplasticity have been posited as causes of detrusor dysfunction. Nevertheless, the lack of consistent preoperative urodynamic investigation makes it difficult to assess the operation's exact role in causing these dysfunctions. Thus, urodynamics performed, at least in selected cases, preoperatively and during follow-up could help arrive at a precise diagnosis of the underlying dysfunction, indicate the appropriate treatment, and prevent the incidence and onset of postoperative urinary incontinence.

Authors+Show Affiliations

Department of Urology and Andrology, University of Perugia, Policlinico Monteluce, Perugia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17403565

Citation

Porena, Massimo, et al. "Voiding Dysfunction After Radical Retropubic Prostatectomy: More Than External Urethral Sphincter Deficiency." European Urology, vol. 52, no. 1, 2007, pp. 38-45.
Porena M, Mearini E, Mearini L, et al. Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency. Eur Urol. 2007;52(1):38-45.
Porena, M., Mearini, E., Mearini, L., Vianello, A., & Giannantoni, A. (2007). Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency. European Urology, 52(1), 38-45.
Porena M, et al. Voiding Dysfunction After Radical Retropubic Prostatectomy: More Than External Urethral Sphincter Deficiency. Eur Urol. 2007;52(1):38-45. PubMed PMID: 17403565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency. AU - Porena,Massimo, AU - Mearini,Ettore, AU - Mearini,Luigi, AU - Vianello,Alberto, AU - Giannantoni,Antonella, Y1 - 2007/03/26/ PY - 2006/12/16/received PY - 2007/03/16/accepted PY - 2007/4/4/pubmed PY - 2007/9/14/medline PY - 2007/4/4/entrez SP - 38 EP - 45 JF - European urology JO - Eur Urol VL - 52 IS - 1 N2 - OBJECTIVES: To analyse the relationship between RRP and urodynamic bladder dysfunction, and compare preoperative and postoperative functional status over long-term follow-up. Hypothesis on the pathophysiologic mechanism underlying urodynamic dysfunction has been reported. METHODS: PubMed databank search for original articles followed by review of urodynamic parameters: bladder filling sensation, detrusor overactivity, bladder compliance, cystometric bladder capacity, impaired detrusor contractility, bladder outlet obstruction, urinary incontinence. RESULTS: Detrusor dysfunction was rarely present as the sole diagnosis and was usually coupled with intrinsic sphincter deficiency. Data on bladder filling sensation, cystometric capacity, detrusor overactivity, impaired detrusor contractility, and bladder outlet obstruction were limited and contradictory. Detrusor overactivity was a de novo dysfunction in 2%-77% of patients. Impaired bladder compliance was present in 8%-39% of patients and was de novo in about 50%. Impaired detrusor contractility was found in 29%-61% of patients, was de novo in 47%, and recovered in about 50% of patients. The role of these dysfunctions as etiologic agents of urinary incontinence or voiding symptoms was unevenly assessed. CONCLUSIONS: Postoperative decentralization of the bladder, inflammation and/or infection, and geometric bladder wall alteration associated with preexisting hypoxemia with/without neuroplasticity have been posited as causes of detrusor dysfunction. Nevertheless, the lack of consistent preoperative urodynamic investigation makes it difficult to assess the operation's exact role in causing these dysfunctions. Thus, urodynamics performed, at least in selected cases, preoperatively and during follow-up could help arrive at a precise diagnosis of the underlying dysfunction, indicate the appropriate treatment, and prevent the incidence and onset of postoperative urinary incontinence. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/17403565/Voiding_dysfunction_after_radical_retropubic_prostatectomy:_more_than_external_urethral_sphincter_deficiency_ DB - PRIME DP - Unbound Medicine ER -