Urodynamic Testing in Evaluation of Postradical Prostatectomy Incontinence Before Artificial Urinary Sphincter Implantation

OBJECTIVES To examine whether the presence of adverse preoperative urodynamic features negatively affects the continence results after artificial urinary sphincter (AUS) surgery. The use of urodynamic testing in the evaluation of postradical prostatectomy incontinence (PPI) before AUS implantation is controversial. METHODS A total of 129 patients with PPI underwent multichannel video-urodynamic evaluations before virgin AUS implantation. The mean follow-up was 34.1 months. The continence results at the last follow-up visit, measured by daily pad use, were compared between the patients with adverse preoperative urodynamic features and those without them. RESULTS The presence of adverse preoperative urodynamic features, such as poor bladder compliance <10 mL/cm, the presence of detrusor overactivity, early sensation of bladder filling at <75 mL, an early first desire to void at <125 mL, reduced cystometric capacity of <200 mL, low abdominal leak point pressure of <30 cm H2O, low peak flow of <10 mL/s, low detrusor pressure at peak flow of < 10 cm, or a bladder contractility index of < 100, did not negatively affect the post-AUS daily pad use (P >.05). The observation that poor bladder compliance did not worsen the AUS continence result was an ominous finding from the perspective of potentially exposing the upper tracts to high intravesical storage pressure. CONCLUSIONS The presence of adverse preoperative urodynamic features did not negatively affect the continence results after AUS implantation in patients with PPI. In selected patients with PPI, urodynamic testing can be used to confirm the diagnosis of intrinsic sphincteric deficiency, rule out pure detrusor dysfunction, identify poor bladder compliance, and quantify the intravesical storage pressure. UROLOGY 73: 1264-1269, 2009. Published by Elsevier Inc.