Preoperative Evaluation of Post-prostatectomy Urinary Incontinence: Examining the Evidence for Routine Use of Multichannel Urodynamics

Purpose of Review Up to 10% of men after radical prostatectomy will experience persistent bothersome urinary incontinence. Multichannel urodynamics is often utilized in the preoperative assessment of men with post-prostatectomy incontinence. However, the routine use of this expensive and invasive diagnostic modality in post-prostatectomy incontinence is debatable. This review highlights the evidence either supporting or refuting the routine use of multichannel urodynamic assessment in the preoperative workup of post-prostatectomy urinary incontinence. Recent Findings Stress urinary incontinence symptoms elucidated on history appears to accurately reflect findings on urodynamic assessment with a positive and negative predictive value of >95 and 100%, respectively. Up to half of men with post-prostatectomy incontinence may have some element of bladder dysfunction (decreased compliance, overactivity, decreased bladder capacity, etc); however, numerous studies have failed to demonstrate an impact of preoperative bladder dysfunction on post-surgical treatment outcomes. Summary The available evidence demonstrates that a thorough history accurately reflects findings on urodynamic assessment. Further, bladder dysfunction, regardless of type, does not appear to impact on post-surgical treatment outcomes in men with post-prostatectomy incontinence. These findings argue against the routine use of multichannel urodynamic assessment in the preoperative assessment. However, unlike female incontinence, large randomized controlled trials testing the impact of preoperative urodynamic findings on surgical treatment outcomes are lacking.