1988 Volume 79 Issue 12 Pages 2012-2020
The vesical and urethral function after radical prostatectomy was studied urodynamically.
Two men with clinical stage A2 and four with stage B2 prostatic cancer underwent radical retropubic prostatectomy between May 1986 and April 1988. The ages at the time of the operation ranged from 58 to 69 years, with an average of 65 years. They underwent a direct urethrovesical anastomosis. Urodynamic evaluation was performed preoperatively and at 1 month, 3 months, 6 months and 1 year after radical prostatectomy.
Anastomotic stricture occurred in four of the six patients, three of whom had successful soft dilatation, while one required the periodic dilatation. Uroflowmetry was useful for early detection of the anastomotic stricture.
One patient undergoing nerve sparing radical prostatectomy presented urinary incontinence for three weeks after the operation. Among three patients whose neurovascular bundles were undissectable because of severe adhesion around prostatic capsule, two recovered continence at 8th and 12th month postoperatively but one remained with slight stress incontinence over 18 months. Two patients, whose neurovascular bundles were resected bilateraly because of tumor invasion, became continent 2 and 3 months after the operation. The findings of pre and postoperative cystometry and external urethral or anal sphincter electromyography were almost normal in all of the six patients.
Postoperative maximum urethral closure pressure was remarkably low but it increased gradually during 2 and 3 months postoperatively in parallel with the improvement of continence with time. Postoperative functional urethral length was remarkably short and somewhat increased with time. Vesicourethrography revealed opened vesical neck and the lack of proximal urethral mobility in a patient with postoperative incontinence.
