Poster, Podium & Video Sessions
Presentation Authors: Joseph LaBossiere*, Sender Herschorn, Toronto, Canada
Introduction: Persistent bothersome urinary incontinence occurs in up to 10-15% of men after radical prostatectomy (RP). Urodynamics (UDS) are often utilized in the assessment of men with post-prostatectomy incontinence (PPI). Our objective is to determine how well patient symptoms correlate with UDS in men with PPI.
Methods: Retrospective review of a cohort of 496 men referred to our institution with PPI over a 20-year period. All patients with a history of RP were included in the study. All patients had a standardized history as well as the original multichannel UDS and interpretation.
Results: 496 patients with an average age of 64 were reviewed accounting for 513 studies. UDS were performed on average 3 years after RP. On history, 471 (91%) patients complained of stress urinary incontinence (SUI), 249 (48%) urgency urinary incontinence (UUI) and 207 (40%) had mixed urinary incontinence (MUI). 264 (52%) of patients had only SUI and 42 (8%) only UUI symptoms. 356 of the 471 patients with a history of SUI symptoms had SUI on UDS for a positive predictive value (PPV) of 75%. Negative predictive value (NPV) for SUI symptoms was 78%. 6% of men complaining of SUI symptoms on history had only detrusor overactivity incontinence (DOI) on UDS, and 18% of men with SUI symptoms demonstrated no incontinence on UDS. 108 of the 249 patients with symptoms of UUI had DOI on UDS for a PPV of 43%. NPV for UUI symptoms was 85%. Of the 42 men complaining only of UUI symptoms, 14% had only SUI, 50% had only DOI and 17% had both SUI and DOI on UDS. 19% of men with only UUI symptoms demonstrated no incontinence on UDS. 77% of patients with MUI symptoms had SUI on UDS.
Conclusions: 91% of men in this study with PPI presented with some element of SUI symptoms on history. SUI symptoms on history accurately predicts SUI on UDS and rarely identifies only DOI. These data question the routine use of UDS in the workup of men presenting with SUI symptoms after RP prior to treatment. Men complaining only of UUI symptoms on history also predicts for DOI on UDS. UDS may be helpful in this patient group to further guide treatment decisions if initial treatment fails and to rule out SUI. Most men with MUI symptoms will have SUI identified on UDS.
Source Of Funding: Source of Funding: None
University of Toronto
Joseph R. LaBossiere MD, MSc, FRCSC. I am currently a clinical fellow in complex urinary incontinence, urodynamics and reconstructive urology at Sunnybrook Health Sciences Centre in Toronto, Ontario. I completed an undergraduate degree in medical sciences and a medical doctor degree with special training in research prior to starting my residency in urology at the University of Alberta. During my residency, I completed a masters degree in experimental surgery and will obtain a masters degree in clinical epidemiology and health care research from the University of Toronto during my fellowship.
Sunday, May 14
3:30 PM – 5:30 PM