After RP, clinical complaints of new onset storage symptoms may be related to anastomotic strictures or as accommodation for stress urinary incontinence; however, a subgroup of men will experience de novo storage symptoms in the absence of stricture or stress urinary incontinence. As therapies for OAB have improved, we sought to assess the prevalence, natural history, and risk factors of de novo storage dysfunction in continent men.
We retrospectively analyzed urinary symptom questionnaires completed by patients who were continent prior to RP and did not have post-operative anastomotic strictures at our institution from 2002-2019. De novo storage dysfunction, assessed as new onset or worsening urgency or frequency was assessed at 6, 12, 18 and 24 months after RP and association between it and patient and preoperative factors determined.
A total of 2619 patients were included in the final analysis. An initial 34% of patients reported de novo storage symptoms at 6 months, which decreased to 26% at later follow-up. We found evidence that minimally invasive surgery and nonwhite race were associated with reporting worsening symptoms. The association between post-operative hematoma and worsening symptoms was less conclusive but was of clear clinical relevance (OR 3.15; 95% CI 1.04, 9.54; p-value=0.042).
A significant number of RP patients experience de novo storage symptoms. Patients who underwent MIS surgery are at higher risk. At risk patients should be counseled on the incidence of de novo storage symptoms and offered early treatment per OAB guidelines.
The Journal of urology. 2021 Oct 25 [Epub ahead of print]
Kathleen M Kan, Amy L Tin, Gillian L Stearns, James A Eastham, Daniel D Sjoberg, Jaspreet S Sandhu
Stanford University., Memorial Sloan Kettering Cancer Center., Atrium Health.