Clinical utility of urodynamics for postprostatectomy incontinence

Understanding the role of urodynamics in postprostatectomy incontinence helps urologic clinicians determine optimal treatment choices. The most common urodynamic diagnosis in men with leakage after prostatectomy is urodynamic stress incontinence usually due to intrinsic sphincter deficiency. Findings of detrusor overactivity and bladder outlet obstruction often coexist. Only urodynamics with pressure-flow study allow accurate diagnosis of physiologic bladder outlet obstruction. Simultaneous fluoroscopy may be useful in further defining or diagnosing clinically significant obstruction. By employing specific urodynamic techniques, one avoids misdiagnosis of incontinence and overdiagnosis of obstruction. Decreased bladder compliance is rare in recent urodynamic studies. With the advent of new surgical techniques for postprostatectomy incontinence such as male perineal and transobturator slings, it is imperative to understand bladder, sphincter, and bladder outlet function. Underlying pathologic conditions may be caused by the treatment of prostate cancer, as well as the treatment of incontinence itself. © 2007 Springer Science+Business Media, LLC.