The leading cause of  postoperative male stress urinary incontinence (SUI) is the iatrogenic urethral sphincter deficiency. The postoperative male SUI (or with modern terms: "postprostatectomy incontinence", or "incontinence after prostate treatment") is still one of the most common major complications after prostate operations (mostly radical prostatectomies) requiering surgical interventions in a significantly high number of cases. However numerous investigations reported about a wide spectrum of bladder dysfunction as the alternative etiopathology of leakage as well. The aim of our study was to analyze the results of preoperative urodynamic studies (UDS) of men who underwent corrective surgery for SUI, assess the frequency of urodynamic abnormalities and determine the possible risk factors that can be considered predictive for the outcome of anti-incontinence operations.

Between October 2010 and November 2021 we performed surgery on 151 male patients with stress urinary incontinence at the Department of Urology of Semmelweis University (Budapest, Hungary). We analyzed the preoperative urodynamic parameters of 127 of them (101 underwent artificial urinary sphincter implantation, 26 were implanted with suburethral slings) with at least 12 months of follow-up.
We divided them into two groups based on the level of their postoperative continence (as "totally" and "partially" continent patients) and compared their preoperative urodynamic parameters: uroflow, post-void residual volume (PVR), bladder capacity, filling sensation,  bladder compliance, detrusor activity, bladder contractility, bladder outlet obstruction and maximal voiding detrusor pressure.

The preoperative UDS confirmed the presence of stress urinary incontinence by every patient, and in 90 cases (70,9%) it also showed some other urodynamic abnormality as well. Comparing the totally continent group (n=61)  with the partially continent group (n=66) there was no significant difference to declare within the preoperative findings. (Single UDS abnormality: 44 vs 46 patients (p=0,84), multiple UDS aberrations: 21 vs 30 (p=0,66).) The most common UDS abnormalities beside the SUI: decreased bladder capacity (46,5%), detrusor overactivity (38,6%), increased sensation (19,7%) – only the latter differed significantly between the two groups (7/61 vs 18/66, p=0,043).

The main reason behind male SUI is the acquired deficiency of the urethral sphincter. Nevertheless, in most cases other urodynamic abnormalities could be proven, these however did not influence the outcome of the anti-incontinence operations, neither did they contraindicate them.

This  does not mean that we should stop doing UDS before surgery. Au contraire! Our group of (operated) obviously do not include the ones where contraindicating factors (severely decreased bladder capacity, detrusor underactivity or significant overactivity) were found.

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