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• W2019923884 abstract "No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jun 2000EFFECT OF RADICAL PROSTATECTOMY ON SENSORY THRESHOLD AND PRESSURE TRANSMISSION HUBERT JOHN, MARYROSE P. SULLIVAN, URS BANGERTER, DIETER HAURI, and SUBBARAO V. YALLA HUBERT JOHNHUBERT JOHN More articles by this author , MARYROSE P. SULLIVANMARYROSE P. SULLIVAN More articles by this author , URS BANGERTERURS BANGERTER More articles by this author , DIETER HAURIDIETER HAURI More articles by this author , and SUBBARAO V. YALLASUBBARAO V. YALLA More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67537-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The mechanisms involved in post-radical prostatectomy incontinence remain unclear despite previous anatomical and functional studies. In addition, the factors responsible for the restoration of continence are not well studied. To improve our understanding of the alterations in continence mechanisms, we prospectively investigated the temporal changes in urodynamic parameters after radical prostatectomy. Materials and Methods: Cystometry, urethral pressure profilometry and posterior urethral sensory threshold measurements were performed in patients undergoing radical prostatectomy. Preoperative pressure transmission was determined by the maximal urethral pressure divided by the maximal abdominal pressure during cough maneuvers at a bladder volume of 200 ml. Postoperative sensory threshold, pressure transmission (% of pressure transmission), maximal urethral closure pressure and functional sphincter length were measured 6 weeks and 6 months after prostatectomy. These parameters were compared between continent and incontinent patients. Results: Preoperative and postoperative urodynamic studies were completed in 34 patients. The continence rate after 6 weeks was 18% (6 patients) and improved to 82% (28) after 6 months. Preoperatively sensory threshold was 16 ± 11 mA. After 6 weeks and 6 months, respectively, sensory threshold was significantly higher in incontinent (84 ± 11 mA., 70 ± 8 mA.) compared to continent (65 ± 8 mA., 41 ± 12 mA.) patients. Preoperative proximal urethral sensory threshold was not correlated with degree of postoperative incontinence determined by pad tests. Pressure transmission was not different in continent and incontinent patients postoperatively. After 6 weeks and 6 months, respectively, pressure transmission was 77% and 91% in continent, and 37% and 58% in incontinent patients (p = 0.04, p = 0.03). Maximal urethral closure pressure was significantly higher in continent patients (35 ± 6 cm. H2O) compared to incontinent patients (11 ± 9 cm. H2O). Sphincter length decreased from 50 mm. preoperatively to 24 mm. after 6 weeks and 25 mm. after 6 months. There was no difference in sphincter length between continent and incontinent patients. Conclusions: Posterior urethral sensitivity and pressure transmission are impaired immediately after prostatectomy. An improvement in these parameters after 6 months is associated with the restoration of continence. These observations suggest that urinary continence after radical prostatectomy depends on the integrity of posterior urethral sensation and the efficiency of pressure transmission. References 1 : Impact of anatomical radical prostatectomy on urinary continence. J Urol1991; 145: 512. Link, Google Scholar 2 : Urodynamische Veränderungen nach radikaler Prostatektomie. Urologe A1997; 36: 535. Google Scholar 3 : Urodynamic assessment of urethral sphincter function in post-prostatectomy incontinence. J Urol1996; 156: 1131. 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Google Scholar From the Clinic of Urology, Zürich University Hospital, Switzerland, and the Division of Urology, West Roxbury Veteran’s Administration Medical Center, Harvard Medical School, Boston, Massachusetts© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byCatarin M, Manzano G, Nóbrega J, Almeida F, Srougi M and Bruschini H (2008) The Role of Membranous Urethral Afferent Autonomic Innervation in the Continence Mechanism After Nerve Sparing Radical Prostatectomy: A Clinical and Prospective StudyJournal of Urology, VOL. 180, NO. 6, (2527-2531), Online publication date: 1-Dec-2008.Kenton K, Simmons J, FitzGerald M, Lowenstein L and Brubaker L (2007) Urethral and Bladder Current Perception Thresholds: Normative Data in WomenJournal of Urology, VOL. 178, NO. 1, (189-192), Online publication date: 1-Jul-2007.COLOMBO R, BERTINI R, SALONIA A, NASPRO R, GHEZZI M, MAZZOCCOLI B, DEHO’ F, MONTORSI F and RIGATTI P (2018) Overall Clinical Outcomes After Nerve and Seminal Sparing Radical Cystectomy for the Treatment of Organ Confined Bladder CancerJournal of Urology, VOL. 171, NO. 5, (1819-1822), Online publication date: 1-May-2004.JOHN H (2018) Bulbourethral Composite Suspension: A New Operative Technique for Post-Prostatectomy Incontinence.Journal of Urology, VOL. 171, NO. 5, (1866-1870), Online publication date: 1-May-2004.GIANNANTONI A, MEARINI E, Di STASI S, MEARINI L, BINI V, PIZZIRUSSO G and PORENA M (2018) ASSESSMENT OF BLADDER AND URETHRAL SPHINCTER FUNCTION BEFORE AND AFTER RADICAL RETROPUBIC PROSTATECTOMYJournal of Urology, VOL. 171, NO. 4, (1563-1566), Online publication date: 1-Apr-2004.GOMHA M and BOONE T (2018) Voiding Patterns In Patients With Post-Prostatectomy Incontinence: Urodynamic And Demographic AnalysisJournal of Urology, VOL. 169, NO. 5, (1766-1769), Online publication date: 1-May-2003.BADER P, HUGONNET C, BURKHARD F and STUDER U (2018) INEFFICIENT URETHRAL MILKING SECONDARY TO URETHRAL DYSFUNCTION AS AN ADDITIONAL RISK FACTOR FOR INCONTINENCE AFTER RADICAL PROSTATECTOMYJournal of Urology, VOL. 166, NO. 6, (2247-2252), Online publication date: 1-Dec-2001.John H and Hauri D (2018) RE: NERVE AND SEMINAL SPARING RADICAL CYSTECTOMY WITH ORTHOTOPIC URINARY DIVERSION FOR SELECT PATIENTS WITH SUPERFICIAL BLADDER CANCER: AN INNOVATIVE SURGICAL APPROACHJournal of Urology, VOL. 166, NO. 4, (1402-1402), Online publication date: 1-Oct-2001.JOHN H, HAURI D, LEUENER M, REINECKE M and MAAKE C (2018) EVIDENCE OF TRIGONAL DENERVATION AND REINNERVATION AFTER RADICAL RETROPUBIC PROSTATECTOMYJournal of Urology, VOL. 165, NO. 1, (111-113), Online publication date: 1-Jan-2001. Volume 163Issue 6June 2000Page: 1761-1766 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordssensory thresholdsurinary incontinencepressureurodynamicsprostatectomyMetricsAuthor Information HUBERT JOHN More articles by this author MARYROSE P. SULLIVAN More articles by this author URS BANGERTER More articles by this author DIETER HAURI More articles by this author SUBBARAO V. YALLA More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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