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Current Bladder Dysfunction Reports

Open Access 19-04-2024 | Prostatectomy | REVIEW

Controversies in Post-Prostatectomy Incontinence Management: Role of Urodynamics Testing and Sequence of Continence Surgery with Salvage Radiation Therapy

Author: Eric Chung

Published in: Current Bladder Dysfunction Reports

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Abstract

Purpose of Review

This paper evaluates the current evidence on the role of urodynamics in prostatectomy incontinence (PPI) and should male sling (MS) or artificial urinary sphincter (AUS) surgery be performed before or after patients receiving radiation therapy in terms of continence outcomes.

Recent Findings

The prevalence of PPI is more common in patients undergoing radical prostatectomy than benign prostatic surgery, and the presence of postoperatively de novo overactive bladder and urge incontinence is not common even without the addition of radiation therapy. Hence, the question arises whether patients presenting with PPI should undergo formal urodynamics testing to exclude detrusor overactivity prior to continence surgery. There is a consensus that the spontaneous recovery of continence is less likely in the setting of salvage radiation therapy. The decision to undertake surgery is likely dictated by patient preference and the urgency for salvage radiation therapy. While the exact choice of MS or AUS, and the sequence of continence surgery in relation to salvage radiation therapy are debatable, irradiated patients are considered a high-risk group with substantially higher risks of postoperative complications.

Summary

Urodynamics should be organized in non-classic SUI or mixed incontinence symptoms with PPI and those who had radiation therapy since it can provide useful information in counselling patients regarding continence outcomes and postoperative expectations. It is important to place greater emphasis on preoperative evaluation and surgical vigilance in irradiated patients with PPI.
Literature
1.••
Sandhu JS, Breyer B, Comiter C, Eastham JA, Gomez C, Kirages DJ et al. Incontinence after prostate treatment: AUA/SUFU guideline. J Urol. 2019;202(2):369–378. This paper combines the position statements from both AUA and SUFU in managing patients with incontinence after prostate treatment.
2.
Huang SW, Tsai CY, Tseng CS, Shih MC, Chien KL, Pu YS, et al. Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ. 2019;367:15919.
3.
Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405–17.CrossRefPubMed
4.
Wu ML, Wang CS, Xiao Q, Peng CH, Zeng TY. The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis. Asian J Androl. 2019;21(2):170–6.CrossRefPubMed
5.
Dovey ZS, Tewari AK. Anatomical robotic prostatectomy: technical factors to achieve superb continence and erectile function. Transl Androl Urol. 2020;9(2):8887–97.CrossRef
6.
Wallis CJD, Glaser A, Hu JC, Huland H, Lawrentschuk N, Moon D, et al. Survival and complications following surgery and radiation for localized prostate cancer: an international collaborative review. Eur Urol. 2018;73(1):11–20.CrossRefPubMed
7.
Uberoi P, Smith CA, Lucioni A. Management of lower urinary tract symptoms after prostate radiation. Curr Urol Rep. 2021;22(7):37.CrossRefPubMed
8.
Biers S, Sievert KD, Thiruchelvam N. Overactive bladder syndrome and lower urinary tract symptoms after prostate cancer treatment. Curr Opin Urol. 2017;27(3):307–13.CrossRefPubMed
9.•
Chung E, Liao L, Kim JH, Wang Z, Kitta T, Lin ATL et al. The Asia-Pacific AMS800 artificial urinary sphincter consensus statement. Int J Urol. 2023;30(2):128–138. This paper serves as a clinical guideline in the various roles of the AMS 800 artificial urinary sphincter device.
10.•
Biardeau X, Aharony S, the AUS Consensus Group, Campeau L, Corcos J. Artificial urinary sphincter: report of the 2015 Consensus Conference. Neurourol Urodyn. 2016;35 Suppl 2:S6–22. This paper provides a nice summary of the artificial urinary sphincter surgery.
11.
Scott FB, Bradley WE, Timm GW. Treatment of urinary incontinence by implantable prosthetic sphincter. Urology. 1973;1:252–6.CrossRefPubMed
12.•
Chung E. Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Trans Androl Urol. 2017;6(Suppl 2):S112-S121. This paper provides a comprehensive review of the current surgical treatments for stress incontinence surgery in male patients.
13.
Silva LA, Andriolo RB, Atallah AN, da Silva EM. Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev. 2014;(9):CD008306
14.
Chung E. A state of art review on the evolution of the urinary sphincter devices for the treatment of post-prostatectomy urinary incontinence: past, present and future innovations. J Med Eng Technol. 2014;38(6):328–32.CrossRefPubMed
15.
Crivellaro S, Morlacco A, Bodo G, et al. Systematic review of surgical treatment of post radical prostatectomy stress urinary incontinence. Neurourol Urodyn. 2016;35(8):875–81.CrossRefPubMed
16.
Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN, Young Academic Urologists Functional Urology Group. The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol. 2013;63(4):681–689
17.
Meisterhofer K, Herzog S, Strini K, Sebastianelli L, Bauer R, Dalpiaz O. Male slings for postprostatectomy incontinence: a systematic review and meta-analysis. Eur Urol Focus. 2020;6(3):575–92.CrossRefPubMed
18.
Chung E, Smith P, Malone G, Cartmill R. Adjustable versus nonadjustable male sling for post-prostatectomy urinary incontinence: a prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months. Neurourol Urodyn. 2016;35(4):482–6.CrossRefPubMed
19.
Park JJ, Hong Y, Kwon A, Shim SR, Kim JH. Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis. Int K Surg. 2023;109(3):401–11.CrossRef
20.•
Abrams P, Constable LD, Cooper D et al. Outcomes of a noninferiority randomised controlled trial of surgery for men with urodynamic stress incontinence after prostate surgery (MASTER). Eur Urol. 2021;79(6):812–823. This paper is the first randomized controlled study comparing male sling and artificial urinary sphincter surgery in patients with postprostatectomy stress incontinence.
21.
Hosier GW, Tennankore KK, Himmelman JG, Gajewski J, Cox AR. Overactive bladder and storage lower urinary tract symptoms following radical prostatectomy. Urology. 2016;94:193–7.CrossRefPubMed
22.
Matsukawa Y, Yoshino Y, Ishida S, Fujita T, Majima T, Funahashi Y, et al. De Novo overactive bladder after robotic-assisted laparoscopic radical prostatectomy. Neurourol Urodyn. 2018;37(6):2008–14.CrossRefPubMed
23.
Watanabe K, Otsuka A, Sano A, Sato R, Matsushita Y, Watanabe H, et al. Predictive factors of de novo overactive bladder in clinically localized prostate cancer patients after robot-assisted radical prostatectomy. Int J Urol. 2023;30(1):57–61.CrossRefPubMed
24.
Ko KJ, Lee CU, Kim TH, Suh YS, Lee KS. Predictive factors of de novo overactive bladder after artificial urinary sphincter implantation in men with postprostatectomy incontinence. Urology. 2018;113:215–9.CrossRefPubMed
25.
Kan KM, Tin AL, Stearns GL, Eastham JA, Sjoberg DD, Sandhu JS. De novo urinary storage symptoms are common after radical prostatectomy: incidence, natural history and predictors. J Urol. 2022;207(3):601–8.CrossRefPubMed
26.
Ficazzola MA, Nitti VW. The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol. 1998;160(4):1317–20.CrossRefPubMed
27.
Barnard J, van Rij S, Westenberg AM. A Valsalva leak-point pressure of >100 cmH2O is associated with greater success in AdVance sling placement for the treatment of post-prostatectomy urinary incontinence. BJU Int. 2014;114(Suppl 1):34–7.CrossRefPubMed
28.
Loertzer H, Huesch T, Kirschner-Hermanns R, et al. Retropubic vs transobturator Argus adjustable male sling: results from a multicentre study. Neurourol Urodyn. 2020;39(3):987–93.CrossRefPubMed
29.
Comiter CV, Sullivan MP, Yalla SV. Correlation among maximal urethral closure pressure, retrograde leak point pressure, and abdominal leak point pressure in men with postprostatectomy stress incontinence. Urology. 2003;62:75–8.CrossRefPubMed
30.
Smith AL, Ferlise VJ, Wein AJ, Ramchandani P, Rovner ES. Effect of A 7-F transurethral catheter on abdominal leak point pressure measurement in men with post-prostatectomy incontinence. Urology. 2011;77(5):1188–93.CrossRefPubMed
31.
Huckabay C, Twiss C, Berger A, Nitti VW. A urodynamics protocol to optimally assess men with post-prostatectomy incontinence. Neurourol Urodyn. 2005;24(7):622–6.CrossRefPubMed
32.
Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn. 2018;37:S50–60.CrossRefPubMed
33.
Porena M, Mearini E, Mearini L, Vianello A, Giannantoni A. Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency. Eur Urol. 2007;52(1):38–45.CrossRefPubMed
34.
Toia B, Leung LY, Saigal R, Solomon E, Malde S, Taylor C, et al. Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence? World J Urol. 2021;39(4):1227–32.CrossRefPubMed
35.
Habashy D, Losco G, Tse V, Collins R, Chan L. Mid-term outcomes of a male retro-urethral, transobturator synthetic sling for treatment of post-prostatectomy incontinence: impact of radiotherapy and storage dysfunction. Neurourol Urodyn. 2017;36(4):1147–50.CrossRefPubMed
36.
Virseda-Chamorro M, Ruiz S, Garcia G, Queissert F, Salinas J, Arance I, et al. Do voiding urodynamic parameters predict the success of adjustable transobturator male system (ATOMS) to treat postprostatectomy urinary incontinence? Neurourol Urodyn. 2020;39(6):1746–52.CrossRefPubMed
37.
Thiel DD, Young PR, Broderick GA, Heckman MG, Wehle MJ, Igel TC, et al. Do clinical or urodynamic parameters predict artificial urinary sphincter outcome in post-radical prostatectomy incontinence? Urology. 2007;69(2):315–9.CrossRefPubMed
38.
Lai HH, Hsu EI, Boone TB. Urodynamic testing in evaluation of postradical prostatectomy incontinence before artificial urinary sphincter implantation. Urology. 2009;73(6):1264–9.CrossRefPubMed
39.
Elliott CS, Comiter CV. Maximum isometric detrusor pressure to measure bladder strength in men with postprostatectomy incontinence. Urology. 2012;80(5):1111–5.CrossRefPubMed
40.
Gammie A, Clarkson B, Constantinou C, Damaser M, Drinnan M, Geleijne G, et al. International Continence Society Guidelines on urodynamic equipment performance. Neurouro Urodyn. 2014;33(4):370–9.CrossRef
41.
Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F et a. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 – Male and neurological population. Minerva Urol Nefrol. 2020;72(2):187–99
42.
Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn. 2018;37(S6):S50–60.CrossRefPubMed
43.
Lee TK, Breau RH, Mallick R, Eapen L. A systematic review of expanded prostate cancer index composite (EPIC) quality of life after surgery or radiation treatment. Can J Urol. 2015;22(1):7599–606.PubMed
44.
Mayer EN, Tward JD, Bassett M, Lenherr SM, Hotaling JM, Brant WO, et al. Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer. BJU Int. 2017;119(5):700–8.CrossRefPubMed
45.
Matta R, Chapple CR, Fisch M, Heidenreich A, Herschorn S, et al. Pelvic complications after prostate cancer radiation therapy and their management: an international collaborative narrative review. Eur Urol. 2019;75(3):464–76.CrossRefPubMed
46.
Martin JM, Richardson M, Siva S, Cardoso M, Handmer M, Sidhorn M. Mechanisms, mitigation, and management of urinary toxicity from prostate radiotherapy. Lancet Oncol. 2022;23(12):e534-543.CrossRefPubMed
47.
Swanson G, Hammonds K. Long-term effects of radiation on lymphocytes and risk of opportunistic infections. Cureus. 2022;14(7):e26887.PubMedCentralPubMed
48.
Swanson G, Hammonds K, Jhavar S. Short-term haematogical effects of androgen deprivation and radiotherapy in prostate cancer patients. Open J Urol. 2021;11:103–11.CrossRef
49.
Ravier E, Fassi-Fehri H, Crouzet S, Gelet A, Abid N, Martin X. Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int. 2015;115:300–7.CrossRefPubMed
50.
Jhavar S, Swanson G, Deb N, Littlejohn L, Pruszynski J, Machen G, et al. Durability of artificial urinary sphincter with prior radiation therapy. Clin Genitourin Cancer. 2017;15:e175–80.CrossRefPubMed
51.
Suardi N, Gallina A, Lista G, Gandaglia G, Abdollah F, Capitanio U, et al. Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. Eur Urol. 2014;65:546–51.CrossRefPubMed
52.
Wright HC, McGeagh K, Richter LA, Hwang JJ, Venkatesan K, Pysher A, et al. Transobturator sling for post-prostatectomy incontinence: radiation’s effect on efficacy/satisfaction. Can J Urol. 2017;24(5):8998–9002.PubMed
53.
Sturm RM, Guralnick ML, Stone AR, Bales GT, Dangle OO, O’Connor RC. Comparison of clinical outcomes between “ideal” and “nonideal” transobturator male sling patients for treatment of postprostatectomy incontinence. Urology. 2014;83(5):1186–8.CrossRefPubMed
54.
Torrey R, Rajeshuni N, Ruel N, Muldrew S, Chan K. Radiation history affects continence outcomes after advance transobturator sling placement in patients with post-prostatectomy incontinence. Urology. 2013;82(3):713–7.CrossRefPubMed
55.
Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol. 2003;4(9):529–36.CrossRefPubMed
56.
Bates AS, Martin RM, Terry TR. Complications following artificial urinary sphincter placement after radical prostatectomy and radiotherapy: a meta-analysis. BJU Int. 2015;116(4):623–33.CrossRefPubMed
57.
Simhan J, Morey AF, Singla N, et al. 3.5 cm artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients. J Urol. 2015;193(2):593–597
58.
Walsh IK, Williams SG, Mahendra V, Nambirajan T, Stone AR. Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction. BJU Int. 2002;89(4):364–8.CrossRefPubMed
59.
Khouri RK Jr, Ortiz NM, Dropkin BM, et al. Artificial urinary sphincter complications: risk factors, workup and clinical approach. Curr Urol Rep. 2021;22(5):30.CrossRefPubMed
60.•
Chung E. Artificial urinary sphincter surgery in the special populations: neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups. Asian J Androl. 2020;22(1):45–50. This paper provides practical considerations in AUS surgery for specific subpopulations and surgical strategies for managing these complex patients.
61.
Chung E and Cartmill R. Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy. BJU Int. 2013;112( Suppl 2):32–35
62.
Ajay D, Zhang H, Gupta S, Selph JP, Belsante MJ, Lentz AC, et al. The artificial urinary sphincter is superior to a secondary transobturator male sling in cases of a primary sling failure. J Urol. 2015;194(4):1038–42.CrossRefPubMed
63.
Martinez EJ, Zuckerman JM, Henderson K, Edwards B, McCammon K. Evaluation of salvage male transobturator sling placement following recurrent stress urinary incontinence after failed transobturator sling. Urology. 2015;85(2):478–82.CrossRefPubMed
64.
Saffarian A, Walsh K, Walsh IK, Stone AR. Urethral atrophy after artificial urinary sphincter placement: is cuff downsizing effective? J Urol. 2003;169:567–9.CrossRefPubMed
65.
DiMarco DS, Elliott DS. Tandem cuff artificial urinary sphincter as a salvage procedure following failed primary sphincter placement for the treatment of postprostatectomy incontinence. J Urol. 2003;170:1252–4.CrossRefPubMed
66.
Guralnick ML, Miller E, Toh KL, Webster GD. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol. 2002;167:2075–8.CrossRefPubMed
Metadata
Title
Controversies in Post-Prostatectomy Incontinence Management: Role of Urodynamics Testing and Sequence of Continence Surgery with Salvage Radiation Therapy
Author
Eric Chung
Publication date
19-04-2024
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-024-00752-8