Overactive Bladder and Storage Lower Urinary Tract Symptoms Following Radical Prostatectomy

Objective To describe the rate of overactive bladder (OAB) and storage lower urinary tract symptoms following radical prostatectomy (RP) and determine if subsequent radiation increases the risk of OAB. Methods We reviewed all patients who underwent open RP at our tertiary care institution from January 2006 to June 2011. Primary outcomes were the proportion of patients with new OAB and time to development of OAB in those treated with RP alone vs RP plus radiation. Secondary outcomes included the proportion of patients treated for OAB. A Cox survival analysis was used to assess the impact of radiation on development of OAB. Results Of the 875 patients who met study criteria, 19% of patients developed de novo OAB defined as urgency with or without frequency and nocturia. A total of 256 patients (29%) developed 1 or more urinary symptoms including nocturia (22%), frequency (21%), urgency (19%), and urge incontinence (6%) following RP. After adjusting for age, body mass index, smoking status, cancer stage, and nerve-sparing status, radiation therapy was associated with an increased relative hazard of OAB (5.59; 95% CI 3.63-8.61, P < .001). Among men classified with de novo OAB, only 41% received treatment. Conclusion OAB and storage lower urinary tract symptoms are prevalent in men post-RP. Adjuvant or salvage radiation therapy increases the risk of developing OAB after RP. OAB may be undertreated in men following prostate cancer treatment.