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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 589-593. doi: 10.19723/j.issn.1671-167X.2024.04.007

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Analysis of risk factors for long-term overactive bladder after radical prostatectomy

Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU*(),Lulin MA*()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-03-14 Online:2024-08-18 Published:2024-07-23
  • Contact: Cheng LIU,Lulin MA E-mail:liuchengmd@163.com;malulinpku@163.com
  • Supported by:
    Peking University Third Hospital Clinical Cohort Project Type C(Y65497-04)

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Abstract:

Objective: To analyze the incidence and progression of overactive bladder (OAB) symptoms following radical prostatectomy for prostate cancer patients and to identify related risk factors. Methods: A retrospective study was conducted on 263 local stage prostate cancer patients who underwent radical prostatectomy at Peking University Third Hospital from January 2013 to May 2017. Clinical baseline information, comprehensive imaging features, perioperative parameters, preoperative urinary control status, pathological diagnosis, and the incidence of OAB within one year postoperatively were collected and analyzed. In the imaging features, two parameters were defined: Bladder wall thickness (BWT) and bladder mucosal smoothness (BMS), which were used to predict the occurrence of OAB. Patients were evaluated based on their clinical baseline characteristics, including age, body mass index (BMI), comorbidities, and prostate-specific antigen (PSA) levels. The imaging characteristics were assessed using preoperative MRI, focusing on BWT and BMS. Perioperative parameters included operative time, blood loss, and length of hospital stay. The OAB symptoms were assessed using the overactive bladder symptom score (OABSS) and the international prostate symptom score (IPSS). These scores were correlated with the postoperative incidence of OAB. Results: Among the 263 patients who underwent radical prostatectomy, 52 (19.8%) exhibited OAB within one year postoperatively. Of the 40 patients with preoperative OAB symptoms, 17 (42.5%) showed remission postoperatively, while 23 (57.5%) had persistent symptoms. Additionally, 29 patients developed new-onset OAB, accounting for 55.77% of all postoperative OAB cases. Univariate analysis indicated that BWT, BMS, OABSS, and IPSS score were all associated with the occurrence of postoperative OAB. Further multivariate analysis identified BMS as an independent risk factor for long-term OAB (P < 0.001). Conclusion: Long-term postoperative overactive bladder is a common complication following radical prostatectomy. The findings suggest that preoperative MRI measurements of bladder wall thickness and bladder mucosal smoothness during bladder filling phase can predict the risk of OAB occurrence postoperatively. Identifying these risk factors preoperatively can help in counseling patients about potential complications and in developing strategies to mitigate the risk of developing OAB after surgery. Early detection and management of these parameters might improve the quality of life for patients undergoing radical prostatectomy.

Key words: Prostate cancer, Radical prostatectomy, Overactive bladder, Risk factors, Prediction

CLC Number: 

  • R737.25

Figure 1

Illustration of bladder mucosal smoothness (BMS) grade categories A, BMS 0 grade, smooth mucosal membrane with uniform thickness of bladder wall; B, BMS 1 grade, slightly uneven mucosal with varied thickness of bladder wall; C, BMS 2 grade, diverticulum of bladder wall and hiatus deep into the muscular membrane, disrupting the continuity of mucosal and muscular wall; D, BMS 3 grade, large-scale trabeculated bladder wall with period absence of muscular tissue."

Table 1

Baseline information between OAB and non-OAB patients following RP"

Items Non-OAB (n=211) With OAB (n=52) Overall (n=263) P Statistical value
Age/years, ${\bar x}$±s 69.8±7.17 70.8±6.66 70.0±7.07 0.375 -0.893
BMI/(kg/m2)，n(%) 0.858 0.766
  18.5-24.9 121 (57.3) 28 (53.8) 149 (56.7)
  ≥25 90 (43.7) 24 (46.2) 114 (43.3)
Total PSA/(μg/L)，n(%) 0.279 3.845
  0- 16 (7.6) 8 (15.4) 24 (9.1)
  4- 86 (40.8) 19 (36.5) 105 (39.9)
  10- 67 (31.8) 11 (21.2) 78 (29.7)
  ≥20 42 (19.9) 14 (26.9) 56 (21.3)
NCCN risk group, n(%) 0.134 7.042
  Very low/ low 6 (2.8) 3 (5.8) 9 (3.4)
  Intermediate 81 (38.4) 13 (25.0) 94 (35.7)
  High 73 (34.6) 21 (40.4) 94 (35.7)
  Very high 51 (24.2) 15 (28.8) 66 (25.1)
Prostate volume/mL, ${\bar x}$±s 46.6±21.3 48.8±25.5 47.0±22.2 0.575 -0.563
Bladder thickness/mm, ${\bar x}$±s 2.82±0.85 3.63±1.84 2.98±1.16 0.003 -3.088
Bladder smoothness, n(%) < 0.001 42.900
  0 smooth 60 (28.4) 7 (13.5) 67 (25.5)
  1 intermediate 122 (57.8) 16 (30.8) 138 (52.5)
  2/3 mild/severe trabecular 29 (13.7) 29 (55.8) 58 (22.1)
Margin, n(%) 0.109 2.574
  Negative 145 (68.7) 29 (55.8) 174 (66.2)
  Positive 66 (31.3) 23 (44.2) 89 (33.8)
Capsule invasion, n(%) 0.968 0.002
  Non-invasion 132 (62.6) 33 (63.5) 165 (62.7)
  Invasion 79 (37.4) 19 (36.5) 98 (37.3)
NVB preservation, n(%) 0.199 3.234
  Preserved 189 (89.6) 43 (82.7) 232 (88.5)
  None 22 (10.4) 9 (17.3) 31 (11.8)
Op_time/min, ${\bar x}$±s 233±78 229±58 233±74 0.658 0.444
eBloodloss/ mL, ${\bar x}$±s 158.36±169.96 125.40±112.87 152.67±160.74 0.208 1.266
Pre_IPSS, ${\bar x}$±s 18.9±7.6 18.3±4.3 18.8±7.1 0.458 0.745
Pre_OABSS, ${\bar x}$±s 7.75±3.57 8.63±2.74 7.92±3.44 < 0.001 -5.022
Post_IPSS, ${\bar x}$±s 10.8±5.5 15.0±3.8 11.6±5.5 < 0.001 -6.451
Post_OABSS, ${\bar x}$±s 4.27±2.22 9.58±3.29 5.32±3.25 < 0.001 -11.014
Incontinence, n(%) < 0.001 21.605
  Continent 186 (88.2) 31 (59.6) 217 (82.5)
  Incontinent 25 (11.8) 21 (40.4) 46 (17.5)

Table 2

Outcomes of binary Logistics regression of multivariate analysis for post radical prostatectomy OAB"

Bladder mucosal smoothness (BMS) OR (95%CI) P
0 1.00
1 6.85 (2.90-16.39) < 0.001
2/3 6.90 (3.24-14.71) < 0.001
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