BERKELEY, CA (UroToday.com) - Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Even in recent series, its prevalence can vary from 6% to 20% in the late postoperative period.[1, 2, 3] The male sling has emerged as a possible treatment for patients with urinary sphincter incontinence after prostate surgery. However, several studies have shown that patients with severe incontinence did not obtain results as satisfactory as those patients with mild to moderate incontinence.[4, 5, 6] Fischer et al. observed in 62 patients, those who had a 24h pad test < 423g showed a success rate six times higher than those who had a test > 423g.[7]
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| Figure 1. Position of anterior bladder neck using an XY coordinates system during contraction. The X axis was drawn by a line on the upper edge of the pubic symphysis. The Y axis was drawn perpendicular to the X axis at the upper edge of the pubic symphysis. |
In our study, we observed that the incontinent group had anterior bladder neck displacement during contraction that was significantly smaller than the continent group (p = 0.008). However, when we divided the incontinent group into mild/moderate and severe incontinence subgroups, we observed that there was a statistically significant difference between them. Only the severe incontinent subgroup (24h pad test > 400g) showed significantly less displacement of the anterior bladder neck than the continent group during contraction (p = 0.022). These ultrasound findings are consistent with the literature and may explain the surgical results of the study by Fischer, et al.[7]
Two-dimensional perineal ultrasound provides more detail about the pathophysiology underlying urinary incontinence after radical prostatectomy. The diagnostic precision it affords could reduce treatment failure by predicting which treatment method should be the most suitable for each patient. It may become an important tool in the selection of patients undergoing male sling after radical prostatectomy.
References:
- Steiner MS, Morton RA, Walsh PC. Impact of anatomical radical prostatectomy on urinary continence. Journal of Urology. 1991; 145:512-4.
- Eastham JA, Kattan MW, Rogers E, Goad JR et al. Risk factors for urinary incontinence after radical prostatectomy. Journal of Urology. 1996; 156:1707-13.
- Majoros A, Bach D, Keszthelyi A, Hamvas A et al. Analysis of risk factors for urinary incontinence after radical prostatectomy. Urologia Internationalis. 2007; 78: 202-7.
- Castle EP, Andrews PE, Itano N et al. The male sling for post-prostatectomy incontinence: mean follow-up of 18 months. Journal of Urology, 2005; 173: 1657-60.
- Giberti C, Gallo F, Schenone M, Cortese P. The boneanchorsuburethral sling for the treatment of iatrogenic male incontinence: subjective and objective assessment after 41 months of mean follow-up. World Journal of Urology. 2008; 26: 173–8.
- Onur R, Rajpurkar A, Singla A. New perineal bone-anchored male sling: Lessons learned. Urology. 2004; 64: 58-61.
- Fischer MC, Huckabay C, Nitti VW. The male perineal sling: assessment and prediction of outcome. Journal of Urology. 2007 Apr; 177(4):1414-8.
Written by:
Danilo Souza Lima da Costa Cruz, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Hospital Universitário Pedro Ernesto
State University of Rio de Janeiro
Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil