Abstract: PD39-06
Sources of Funding: None

Introduction

After radical prostatectomy (RP), clinical complaints of new onset storage symptoms may be related to anastomotic strictures, however a subgroup of men with normal urinary function at baseline will experience de novo storage symptoms in the absence of this anastomotic pathology. With the advent of multiple treatments for overactive bladder, we sought to assess the prevalence, natural history, and risk factors of de novo storage dysfunction in order to improve our counseling and treatment efforts for these patients.

Methods

We retrospectively analyzed urinary symptom questionnaires completed by patients who were continent at baseline and did not have post-operative anastomotic strictures at our institution from 2002-2015. De novo storage dysfunction, assessed as new onset or worsening urgency, frequency, or nocturia, was assessed at 6, 12, 18 and 24 months after RP. Fisher’s exact test and Wilcoxon rank-sum test were used to assess association between patient and perioperative characteristics with these voiding symptoms at 12 months.

Results

874 patients were included in the final analysis. An initial 34% of patients reported de novo storage symptoms at 6 months, which decreased to 25% and remained stable at 12, 18 and 24 months. Frequency of urination is the most commonly reported symptom at 12 months (62%) followed by difficulty postponing urination (40%), leakage (35%) and nocturia (3.7%). Younger men (median 61 vs 59 year, p=0.032) and those with a higher BMI (27.5 vs 28.2, p=0.049) are more likely to report worsening symptoms. However, differences between groups are small. For example, the probability of storage dysfunction is 23% for a patient with a BMI of 25 compared to 26% for a patient with a BMI of 30. No significant association was identified between prostate volume, prior TURP, EBL, operative time, postoperative leakage or hematoma, ASA, Charlson comorbidity index score or pathologic tumor characteristics.

Conclusions

There is a subgroup of patients post-RP who will experience de novo storage symptoms in the absence of an anastomotic stricture. Younger patients and those with a higher BMI may be at a higher risk, reflecting a broader clinical picture where patients with little to no urinary bother may be more acutely aware of new storage symptoms and those with a higher pre-operative weight may more commonly develop urinary leakage that stimulates a reflex detrusor contraction. At risk patients should be counseled on the incidence of de novo storage symptoms in the perioperative period. _x000D_ _x000D_

Funding

None