Bladder and Urethral Sphincter Function after Radical Retropubic Prostatectomy: A Prospective Long-Term Study

• Published in: European urology 2008-09, Vol.54 (3), p.657-664
• Main Authors: Giannantoni, Antonella, Mearini, Ettore, Zucchi, Alessandro, Costantini, Elisabetta, Mearini, Luigi, Bini, Vittorio, Porena, Massimo
• Format: Article
• Language: English
• Subjects: Aged; Chi-Square Distribution; Follow-Up Studies; Humans; Longitudinal Studies; Male; Prospective Studies; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - physiopathology; Prostatic Neoplasms - surgery; Radical retropubic prostatectomy; Statistics, Nonparametric; Treatment Outcome; Urethra - physiopathology; Urinary Bladder - physiopathology; Urination Disorders - etiology; Urination Disorders - physiopathology; Urodynamics; Urology; Voiding dysfunction
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2007.10.054

Abstract Objective In a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up. Methods Fifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3–7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD). Results There was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo ( p < 0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up ( p < 0.05 and p < 0.001). Conclusions Following RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.