The Role of Urodynamics in Assessing Lower Urinary Tract Symptoms Post-Radical Prostatectomy: A Review.

Introduction: This review examines the role of urodynamics (UDS) in evaluating lower urinary tract symptoms (LUTS) following radical prostatectomy. We first present typical urodynamic findings in post-prostatectomy men, then discuss applications of UDS, and finally examine treatment pathways for post-prostatectomy LUTS beyond stress urinary incontinence (SUI) surgery.

Methods: A narrative review was performed focusing on the current primary literature and society guidelines on the role of UDS post-prostatectomy.

Results: LUTS after prostatectomy are common, most frequently storage LUTS, specifically SUI. For the index patient with clinically suspected SUI after prostate treatment, routine UDS before SUI surgery have not been shown to impact postsurgical continence outcomes. In cases where there is diagnostic uncertainty following noninvasive lower urinary tract evaluation, UDS plays an important role. UDS are highly beneficial in complex scenarios, such as severe mixed LUTS, prior radiation therapy, impaired bladder compliance, detrusor underactivity, and/or previous SUI surgery. Fluoroscopy during UDS and cystoscopy can provide additional clarity and confirmation of the diagnosis suggested by UDS.

Conclusion: UDS are useful adjuncts in appropriately selected post-prostatectomy patients with LUTS, typically with complicating factors.