Lower Urinary Tract Functional Assessment of Men Undergoing Radical Prostatectomy: Correlation of Preoperative Clinical and Urodynamic Parameters

Abstract

To assess baseline clinical and urodynamic profiles of a contemporary cohort of men undergoing radical prostatectomy as part of the ROSE study. Methods: Men with localised prostate cancer undergoing radical prostatectomy were prospectively recruited to undergo clinical assessment and urodynamic testing prior to surgery as part of a clinical trial. Results: 85 men with median age 64.5 years and median PSA 6.3 ng/ml were prospectively recruited. Of patients with complete baseline data, 36(50.7%), 28(39.4%) and 7(9.9%) had mild (IPSS <8), moderate (IPSS 8-19) and severe (IPSS>20) LUTS. Obstruction was identified in 18 (29.5%) men and 9 (14.8%) showed detrusor underactivity. Of 15 patients with detrusor overactivity, 12(80%) reported OAB. Of men with urodynamic obstruction, 5 (31.3%), 10(62.5%) and 1(6.3%) reported mild, moderate and severe LUTS. Of men without OAB, 4 (11.8%, p=0.002) showed filling phase abnormalities, 13 (46.4%, p=0.611) had flow rates < 15ml/s and 7 (30.4%, p=0.767) were obstructed. Of men with mild or absent LUTS, 5 (20%, p=0.072) were obstructed and 4 (16%, p=0.524) showed poor contractility. Conclusion: LUTS and OAB are common in men with localised prostate cancer undergoing radical prostatectomy. Detrusor overactivity and urodynamic filling phase abnormalities are strongly correlated with OAB. IPSS did not correlate well with bladder outflow obstruction or detrusor underactivity. Urodynamic filling abnormalities were found in 11.8% of men without OAB. Symptomatic and functional assessment may therefore have a role in the preoperative counselling of patients and possibly guide post-operative management of LUTS especially if OAB is present.

De Novo Detrusor Underactivity and Other Urodynamic Findings after Radical Prostatectomy: A Systematic Review

“…It has been previously shown that 12.1–56% of men undergoing radical prostatectomy (RP) have preoperative LUTS [ 48 , 49 ]. In a recent study by Walker et al, mild, moderate, and severe LUTS were reported by 50.7%, 39.4%, and 9.9% of patients, respectively [ 6 ]. This may be attributed to bladder dysfunction as well as BOO from benign or, less frequently, malignant enlargement of the prostate [ 6 , 50 ].…”

“…In a recent study by Walker et al, mild, moderate, and severe LUTS were reported by 50.7%, 39.4%, and 9.9% of patients, respectively [ 6 ]. This may be attributed to bladder dysfunction as well as BOO from benign or, less frequently, malignant enlargement of the prostate [ 6 , 50 ]. Detrusor dysfunction such as DO and DU were reported in 17.4% and 14.8% of men, respectively, whereas BOO in 29.5% [ 6 ].…”

“…This may be attributed to bladder dysfunction as well as BOO from benign or, less frequently, malignant enlargement of the prostate [ 6 , 50 ]. Detrusor dysfunction such as DO and DU were reported in 17.4% and 14.8% of men, respectively, whereas BOO in 29.5% [ 6 ]. This systematic review revealed higher median rates of these alterations, which may be due to the selection of screened population limited to patients who had UDS both before and after the surgery, according to the predefined outcomes.…”

“…Although less frequently studied, other LUTS are not uncommon after RP [ 5 ]. Unfortunately, the high preoperative incidence of LUTS further complicates research on the impact of surgery on lower urinary tract (LUT) function afterwards [ 6 , 7 , 8 , 9 ].…”

Rac1 as a Target to Treat Dysfunctions and Cancer of the Bladder

“…The prevalence of OAB symptoms has been found to be higher in patients receiving brachytherapy (internal radiation therapy) for prostate cancer compared to other treatment modalities [ 140 ]. LUTS and OAB are common in men with localized prostate cancer undergoing radical prostatectomy [ 141 , 142 ]. There is a link between prostatectomy and urinary bladder hypertrophy/dysfunctions [ 143 ].…”