A urodynamics protocol to optimally assess men with post-prostatectomy incontinence

Current Perspectives on Complications of Surgical Treatments for Male Stress Urinary Incontinence

INTRODUCTION

Treatments for male stress urinary incontinence (SUI) include behavioral modifications, pelvic floor strengthening exercises, bulking agents, and surgical management. The most common surgical therapies for male stress incontinence include male slings and artificial urinary sphincters. Complications of these treatments are discussed in this review.

AIM

To review the current literature on SUI diagnosis and the management of common complications that occur after surgical treatments of male SUI.

METHODS

A literature search was performed using PubMed and Ovid to identify leading articles on the management of male SUI and the diagnosis and management of operative complications for male incontinence surgery.

MAIN OUTCOME MEASURE

Main outcomes measured were complications and management strategies for operative complications after surgical therapies for male SUI.

RESULTS

26 publications were cited after an extensive review of the current literature on surgical treatment of male SUI. Commonly cited issues included infection, erosion, and recurrent incontinence after implantation of male slings and artificial urinary sphincters.

CONCLUSION

Complications are inherent to any surgery; a thorough understanding of complications and treatment strategies after surgery for male SUI is essential for the practicing clinical urologist. Shelton TM, Brimley S, Tsambarlis P, Hellstrom WJG. Current Perspectives on Complications of Surgical Treatments for Male Stress Urinary Incontinence. Sex Med Rev 2020;8:443-449.

When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population

Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.

International Consultation on Incontinence 2016; Executive summary: Urodynamic testing

AIMS

The International Consultation on Incontinence has published an update of the recommendations for the diagnosis and management of urine incontinence (ICI2016). This manuscript summarizes the consultations committee-recommendations with regard to urodynamic assessment.

METHODS

Expert consensus on the basis of structured evidence assessment has been the basis of the consultations publication and has been summarized by the committee for this manuscript.

RESULTS

Patients that are not satisfied with their initial management on the basis of their reported signs and symptoms of urinary incontinence, as well as all patients with neurological abnormalities that are potentially relevant for the function of the lower urinary tract, may very likely profit from objective diagnosis and staging and grading of their dysfunction, with urodynamic testing, regardless their age, vulnerability and/or comorbidities. The principles and technical innovations as well as the principal recommendations for the utilization of (invasive) urodynamic assessment for women, men, children, and vulnerable elderly, with or without neurogenic lower urinary tract dysfunction with urinary incontinence are provided in this abbreviated ICI recommendations-document.

CONCLUSIONS

The ICI2016 committee on urodynamics presents an executive summary of the most important reasons and recommendations for the use of urodynamic investigations for patients with urinary incontinence.

Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence

OBJECTIVE

In severe post-prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study evaluated cystometry and pressure flow studies (PFS) in men in whom severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Men who had undergone prior radical prostatectomy were identified from a database of patients attending for video urodynamic testing between 2012 and 2017. Symptom scores, bladder diary and free flow rate tests were retrieved. Measurements of the subgroup of men for whom a Thomson-Walker compression clamp was used to enable full urodynamic evaluation were evaluated. 166 patients were identified. In 30 patients (18%), severe SUI led to incomplete filling cystometry. Following application of the penile compression clamp, further filling was achieved in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs. 46.5 cm H₂ O; P < 0.001), volume at strong desire to void (132 vs. 242 mL; P = 0.003) and cystometric capacity (226 mL with clamp applied vs. 310 mL; P < 0.001) than the overall post-prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs. 22 cm H₂ O; P = 0.009). A penile clamp applied at the time when leakage becomes excessive during filling cystometry avoids premature test termination in men with severe incontinence.

Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence-a review

Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox^®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox^® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.

Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really?

INTRODUCTION

The implications of post-prostatectomy urinary incontinence (PPI) on quality of life pose a matter of great concern for urologists and patients alike. Efforts to mitigate this devastating complication have met with varying degrees of success and the literature has shown a discrepancy between patient- and surgeon-reported outcomes.

AIM

To describe the multifactorial physiology of PPI, its evaluation, and its effect on health-related quality of life and sexual function and to review preoperative predictive factors for PPI and explore the disparity between patient- and surgeon-reported outcomes.

METHODS

We selected a representative sample of principal studies addressing these topics pertaining to PPI. The search was executed by a relevant term search on PubMed from 1994 to the present.

MAIN OUTCOME MEASURES

The main topics of consideration in this review are pathophysiology, predictors and prevalence, and methods of evaluating PPI. We also report on findings on the role of PPI in sexual activity, surgical methods to prevent PPI, and variability in methods of outcome reporting.

RESULTS

The application of various measures to prevent PPI has had variable success and efforts to further refine and widely implement improvements have been complicated by the heterogeneity in measurements used to report and compare outcomes.

CONCLUSION

Patient age, incontinence definitions, and preoperative baseline incontinence make collecting and interpreting urinary function data after radical prostatectomy challenging. Confusion in the literature is compounded by the discrepancy between patient- and surgeon-reported outcomes. On a patient-physician level, there is the issue of potentially under-counseling patients during preoperative discussions on the profound impact of PPI on quality of life in general and on sexual function and satisfaction in particular. Trofimenko V, Myers JB, Brant WO. Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really? Sex Med Rev 2017;5:536-543.

Guideline of guidelines: urinary incontinence

The objective of the article is to review key guidelines on the management of urinary incontinence (UI) to guide clinical management in a practical way. Guidelines produced by the European Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialised guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument was used to evaluate the quality of these guidelines. There is general agreement between the groups on the recommended initial evaluation and the use of conservative therapies for first-line treatment, with a limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures; however, generally the mid-urethral sling is recommended for uncomplicated stress UI, with different recommendations on the approach, as well as the comparability to other treatments, such as the autologous fascial sling. This 'Guideline of Guidelines' provides a summary of the salient similarities and differences between prominent groups on the management of UI.

Urodynamic evaluation before and immediately after robot-assisted radical prostatectomy

OBJECTIVE

To evaluate continence status and mechanism of urinary incontinence immediately after robot-assisted radical prostatectomy (RARP) by performing urodynamic evaluation.

METHODS

A total of 87 patients with localized prostate cancer who underwent RARP were included. Filling cystometry, urethral pressure profilometry, and abdominal leak point pressure (ALPP) tests were performed before and immediately after RARP.

RESULTS

The mean urine loss ratio (ULR), calculated by dividing the total urine volume by the weight of urine loss after RARP, was 17.8%. Nerve-sparing (NS) surgery significantly affected ULR compared with non-NS surgery. In the comparison between preoperative and postoperative results, the mean maximal cystometric capacity (MCC) and maximal closure urethral pressure (MUCP) decreased from 341 mL and 84.6 cm H2O to 250 mL and 35.6 cm H2O, respectively. No urine leakage was observed in ALPP test preoperatively; however, urine leakage was observed postoperatively in 75 patients (86%), with a mean ALPP of 47.7 cm H2O. Multivariate analysis revealed that MCC, MUCP, and ALPP after RARP were predictive factors for ULR. Linear correlations were found between ULR and MUCP and between ULR and ALPP after RARP. NS status and MUCP after RARP (r=0.247; P=.021) and the ALPP (r=0.254; P=.018) were significantly correlated.

CONCLUSION

In urodynamic evaluation immediately after RARP, MCC, MUCP, and ALPP were found to predictive factors for urinary incontinence. The NS procedure contributed to continence status after RARP.

Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study

PURPOSE

Many investigators have used the number of pads to determine the severity of post-prostatectomy incontinence and yet the accuracy of this tool remains unproven. We determined whether the patient perception of pad use and urine loss reflects actual urine loss. We also identified a quality of life measure that distinguishes patients by severity of incontinence.

MATERIALS AND METHODS

We prospectively enrolled 235 men from a total of 18 sites 6 months or more after radical prostatectomy who had incontinence requiring protection. Patients completed a questionnaire on the perception of pad number, size and wetness, a quality of life question, several standardized incontinence questionnaires and a 24-hour pad test that assessed pad number, size and weight. SPSS® was used for statistical analysis.

RESULTS

Perception of the number of pads used closely agreed with the number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p <0.001). Patients with wet and soaked pads had statistically and clinically significantly different pad weights that were uniquely different from each other and from those of patients who were almost dry and slightly wet. Response to the quality of life question separated the men into 4 statistically significantly different groups based on mean 24-hour pad weight.

CONCLUSIONS

Patients accurately described the number, size and degree of wetness of pads collected during a 24-hour pad test. These values correlated well with actual urine loss. The single question, "To what extent does urine loss affect your quality of life?" separated men into distinct categories.

The evidence for urodynamic investigation of patients with symptoms of urinary incontinence

Urodynamic studies are the gold standard to objectively diagnose dysfunction of the lower urinary tract. The widely available evidence for the clinical relevance is, however, fragmented. This article summarizes the published knowledge supporting the use of urodynamic studies in urinary incontinence in female, male and frail patients, as well as patients with relevant neurological disease. Five technological innovations are discussed briefly. Standard urodynamic cystometry can, on the basis of a solid body of evidence, objectively unveil the entire function of the lower urinary tract in all patients with urinary incontinence, regardless of the patients' perception of (ab-)normality of signs and or symptoms.

Urodynamic studies in adults: AUA/SUFU guideline

PURPOSE

The authors of this guideline reviewed the literature regarding use of urodynamic testing in common lower urinary tract symptoms. The findings are intended to assist clinicians in the appropriate selection of urodynamic tests, following an evaluation and symptom characterization.

MATERIALS AND METHODS

A systematic review of the literature using the MEDLINE® and EMBASE databases (searched from 1/1/90 to 3/10/11) was conducted to identify peer-reviewed publications relevant to using urodynamic tests for diagnosis, determining prognosis, guiding clinical management decisions and improving patient outcomes in patients with various urologic conditions. The review yielded an evidence base of 393 studies after application of inclusion/exclusion criteria. These publications were used to create the evidence basis for characterizing the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinion.

RESULTS

The evidence-based guideline statements are provided for diagnosis and overall management of common LUTS conditions.

CONCLUSIONS

The Panel recognizes that each patient presenting with LUTS is unique. This Guideline is intended to serve as a tool facilitating the most effective utilization of urodynamic testing as part of a comprehensive evaluation of patients presenting with LUTS.

Treatment of post-prostatectomy incontinence with male slings in patients with impaired detrusor contractility on urodynamics and/or who perform Valsalva voiding

PURPOSE

Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for urodynamics can be safely treated with slings.

MATERIALS AND METHODS

A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status. Exclusion criteria were lack of preoperative urodynamics and/or postoperative post-void residual. A total of 92 patients were analyzed. The variables were compared using the Student t test and the chi-square test.

RESULTS

No statistically significant difference was shown in postoperative post-void residual (mean 4 months postoperatively) or urinary retention when comparing by bladder contractility or Valsalva voiding. In the subset of patients with available postoperative uroflow data, there were no differences in postoperative maximum flow rate or voided volume.

CONCLUSIONS

Men with post-prostatectomy urinary incontinence with urodynamic findings suggesting impaired contractility or Valsalva voiding can be safely treated with sling surgery if they have normal preoperative emptying.

Management of male urinary incontinence

The majority of male urinary incontinence seen is secondary to sphincter weakness following prostatic surgery. As there is a rising elderly population and increasing numbers of surgical interventions for prostate cancer, incidence of male incontinence is increasing. Hence, management of male incontinence has become a subject of increased interest for urologists. Various non-surgical and surgical approaches have been suggested for this devastating condition. Non-invasive therapies are suggested for early postoperative and mild incontinence. For surgical treatment the artificial urinary sphincter is still labeled the gold standard despite the introduction of several more minimally invasive treatments. However, as yet there is no consensus on the optimal timing and best modality for managing these men. Well designed, centrally funded clinical trials are required to establish which treatment modality to offer and when in the broad spectrum of male incontinence. This review focuses mainly on the management of post-prostatectomy incontinence since the management of other types varies little from the modalities of treatment in women.

Impact of Sacral Surface Therapeutic Electrical Stimulation on Early Recovery of Urinary Continence after Radical Retropubic Prostatectomy: A Pilot Study

Objectives. To investigate whether sacral surface therapeutic electrical stimulation (SSTES) initiated during the early postoperative period would be effective towards early recovery of postprostatectomy urinary continence. Methods. A total of 35 consecutive patients who underwent radical prostatectomy by a single surgeon were enrolled in this study. Twenty early patients began pelvic floor muscle exercise (PME). Fifteen subsequent patients received SSTES postoperatively with no instruction for PME provided. Immediate urinary function just after catheter removal was evaluated with frequency-volume chart and 24-hour pad test. Results. There were no differences between the SSTES and PME groups in maximum voided volume capacity (MVV) and urine loss ratio (ULR) on the first day after removal of urethral catheter. However, on day 3 MVV was significantly larger and ULR was also significantly lower in the SSTES group. Conclusions. SSTES treatment is feasible and appears to be effective for early recovery of urinary continence after radical prostatectomy.

[Management of male urinary incontinence after radical prostatectomy (CTMH AFU 2006-1/5): incidence and role of urodynamic assessment and electromyography]

The incidence of postprostatectomy urinary incontinence varies according to the technique used, over time and according to the type of management, with an incidence at one year ranging from just a few percent to more than 60%. Assessment is required in the case of persistent disabling urinary incontinence despite well conducted perineal rehabilitation one year after surgery or earlier in the case of severe incontinence. Urodynamic assessment is the essential examination to quantify urethral closure pressure. A review of the literature of urodynamic assessment and electromyography is presented.

Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study

OBJECTIVE

In a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up.

METHODS

Fifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3-7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD).

RESULTS

There was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo (p<0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up (p<0.05 and p<0.001).

CONCLUSIONS

Following RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.

The Male Perineal Sling: Assessment and Prediction of Outcome

PURPOSE

The male perineal sling has become an option for treating male stress incontinence. We evaluated its overall efficacy and determined preoperative parameters that could predict success.

MATERIALS AND METHODS

A total of 62 men with stress incontinence were prospectively evaluated and underwent a male perineal sling. Preoperatively 24-hour pad weight, urodynamics and a number of validated incontinence questionnaires were completed. At a minimum of 3 months of followup 24-hour pad weight and questionnaires were repeated. Success was assessed using the 1 question Patient Global Impression of Improvement. The Patient Global Impression of Improvement was compared to a number of other subjective and objective measures of outcome. Finally, preoperative parameters were evaluated to determine predictors of outcome.

RESULTS

As determined by the Patient Global Impression of Improvement, the success rate was 58%. The only preoperative factor predictive of success was 24-hour pad weight. An individual had a 71% chance of successful surgery if preoperative pad weight was less than 423 gm. There was a statistically significant difference between successes and failures in terms of postoperative pad weight and certain questionnaires, including the UCLA/RAND Prostate Cancer Index urinary function score, International Consultation on Incontinence short form, Incontinence Impact Questionnaire, Urogenital Distress Index and International Prostate Symptom Score. The overall complication rate was 21% and the reoperation rate was 14.5%.

CONCLUSIONS

The male perineal sling can be an effective surgical treatment for stress incontinence in the appropriate patient. The procedure is most successful in patients with lesser objective degrees of incontinence. The Patient Global Impression of Improvement is an effective tool for assessing outcome for this population.

Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency

OBJECTIVES

To analyse the relationship between RRP and urodynamic bladder dysfunction, and compare preoperative and postoperative functional status over long-term follow-up. Hypothesis on the pathophysiologic mechanism underlying urodynamic dysfunction has been reported.

METHODS

PubMed databank search for original articles followed by review of urodynamic parameters: bladder filling sensation, detrusor overactivity, bladder compliance, cystometric bladder capacity, impaired detrusor contractility, bladder outlet obstruction, urinary incontinence.

RESULTS

Detrusor dysfunction was rarely present as the sole diagnosis and was usually coupled with intrinsic sphincter deficiency. Data on bladder filling sensation, cystometric capacity, detrusor overactivity, impaired detrusor contractility, and bladder outlet obstruction were limited and contradictory. Detrusor overactivity was a de novo dysfunction in 2%-77% of patients. Impaired bladder compliance was present in 8%-39% of patients and was de novo in about 50%. Impaired detrusor contractility was found in 29%-61% of patients, was de novo in 47%, and recovered in about 50% of patients. The role of these dysfunctions as etiologic agents of urinary incontinence or voiding symptoms was unevenly assessed.

CONCLUSIONS

Postoperative decentralization of the bladder, inflammation and/or infection, and geometric bladder wall alteration associated with preexisting hypoxemia with/without neuroplasticity have been posited as causes of detrusor dysfunction. Nevertheless, the lack of consistent preoperative urodynamic investigation makes it difficult to assess the operation's exact role in causing these dysfunctions. Thus, urodynamics performed, at least in selected cases, preoperatively and during follow-up could help arrive at a precise diagnosis of the underlying dysfunction, indicate the appropriate treatment, and prevent the incidence and onset of postoperative urinary incontinence.

Imaging for urinary incontinence: a contemporary perspective

PURPOSE OF REVIEW

To highlight the current role of the imaging techniques in urinary incontinence.

RECENT FINDINGS

The text for the Third International Consultation of Incontinence, published in 2005, provides major insights into all the imaging techniques. In addition, the most important findings regarded imaging technique in the patients surgically treated for stress urinary incontinence. An article from Singapore suggested that about one-third of patients with tension-free vaginal tape had the tape in the proximal or distal one-third of the urethra, without jeopardizing tape's clinical efficacy. This finding would tend to indicate that the support of the midurethra, as suggested by the integral theory of incontinence, might not be mandatory. Another interesting article demonstrated by ultrasonography, a surprisingly high rate of collagen retention in patients who had undergone collagen injection for stress urinary incontinence due to intrinsic sphincter deficiency.

SUMMARY

Most of the articles published underscored the role of ultrasonography and/or magnetic resonance imaging in assessing the patients with urinary incontinence. The purpose of the imaging is to investigate the correlations between morphology and function of both the bladder and the urethra, and detect concomitant defects in the pelvic floor. Definitive studies comparing the different diagnostic options, as well as their impact on patient management and outcome are still lacking.

Comparison between reduction in 24-hour pad weight, International Consultation on Incontinence-Short Form (ICIQ-SF) score, International Prostate Symptom Score (IPSS), and Post-Operative Patient Global Impression of Improvement (PGI-I) score in patient evaluation after male perineal sling

AIMS

We assessed the utility of three self-assessment instruments: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the post-operative Patient Global Impression of Improvement (PGI-I) score, and the International Prostate Symptom Score (IPSS) by correlating them with an objective outcome, the change in 24-hr pad weight, after a male perineal sling.

METHODS

Twenty-six men with urodynamically confirmed stress incontinence underwent a male perineal sling. Patients were evaluated pre-operatively and post-operatively with a 24-hr pad test, IPSS and ICIQ-SF. Patients also completed the PGI-I post-operatively. Changes in study parameters were compared via the paired t-test, and correlations were performed using Spearman's rho.

RESULTS

There were significant reductions in 24-hr pad weight (-274 g, P < 0.001), percentage 24-hr pad weight (54.2%), ICIQ-SF score (-6.3, P < 0.001), and the three ICIQ-SF subscores (-1.2, -1.7, -3.4 for Questions 3, 4, and 5, respectively, P < 0.001 for all). The change in total ICIQ-SF score and the post-operative PGI-I score correlated strongly with percentage reduction in 24-hr pad weight (r = -0.68, P < 0.001; r = -0.81, P < 0.001, respectively) and with each other (r = 0.79, P < 0.001). The change in all three ICIQ-SF subscores correlated significantly with percentage reduction in 24-hr pad weight and with post-operative PGI-I score. There was no significant change in the IPSS or the voiding or storage subscores, and none correlated with any other study parameter.

CONCLUSIONS

This study validates the construct validity of the ICIQ-SF and PGI-I in the assessment of treatment for male stress incontinence and should make clinicians confident in comparing studies of incontinence treatment utilizing the change ICIQ-SF score, the post-operative PGI-I score, and percentage reduction in 24-hr pad weight as outcome measures.