Implantation of Artificial Urinary Sphincter in Patients With Post-Prostatectomy Incontinence, and Preoperative Overactive Bladder and Mixed Symptoms

Purpose: We assessed the impact of preoperative overactive bladder on the continence results of artificial urinary sphincter implantation, and describe the rates and risk factors associated with the development of de novo and persistent overactive bladder after artificial urinary sphincter surgery. Materials and Methods: A total of 129 consecutive patients treated with radical prostatectomy who had preoperative videourodynamics and virgin artificial urinary sphincter implantation were included in the study. During preoperative and postoperative visits patients were specifically queried about overactive bladder symptoms, anticholinergic medication use and continence status. Results: The presence of concomitant overactive bladder symptoms before artificial urinary sphincter surgery did not negatively impact the overall continence results of the artificial urinary sphincter. De novo overactive bladder developed after artificial urinary sphincter surgery in up to a fourth (23%) of patients with pure stress incontinence (no overactive bladder). Most patients (71%) with preoperative mixed stress urinary incontinence plus overactive bladder symptoms continued to have persistent overactive bladder after artificial urinary sphincter surgery despite marked improvement of incontinence. Patients with a low preoperative cystometric capacity of 200 ml or less were more likely to have overactive bladder after artificial urinary sphincter surgery. Other clinical and urodynamic factors (eg the presence of detrusor overactivity) were not predictive. No risk factors predicted the development of de novo overactive bladder after artificial urinary sphincter surgery. Conclusions: The presence of preoperative overactive bladder does not adversely impact the overall continence results of the artificial urinary sphincter. Patients with mixed stress urinary incontinence plus overactive bladder symptoms pre-operatively should not be denied the male incontinence surgery (artificial urinary sphincter) unless the overactive bladder symptoms are intractable. De novo and persistent overactive bladder occurs commonly after artificial urinary sphincter surgery. Thorough preoperative counseling is imperative to align patient expectations.