Urinary bladder hypertrophy and overactive bladder determine urinary continence after radical prostatectomy

Abstract

Background: Several clinical and biological factors exacerbate urinary incontinence (UI) and reduce the patient's quality of life after radical prostatectomy (RP).

Objectives: The purpose of this study was to evaluate the effects of urinary bladder hypertrophy and overactive bladder (OAB) on UI in patients after RP.

Material and methods: Seventy patients were enrolled in the study and were divided into 2 groups: patients with bladder outlet obstruction (BOO) but without OAB (group I; n = 20) and patients with BOO and OAB (group II; n = 50). Before the RP procedure, all patients were administered IPSS and OAB symptom questionnaires and ultrasonography and uroflowmetry were performed. The follow-up visits were scheduled for 1, 3, 6, 9, and 12 months after the operation to evaluate postoperative continence.

Results: The results show that patients with BOO and concurrent OAB experienced urinary bladder hypertrophy. Patients with OAB presented a normal desire to void with less urinary bladder capacity. The coexistence of OAB before RP resulted in more extensive UI, as measured with the ICIQ-UI-SF scores and postoperative daily pad usage. A gradual improvement in urinary continence was observed. Urinary incontinence was significantly less severe in successive check-ups (3, 6, 9, and 12 months after RP). Urgency was responsible for 1-15% or 16-29% of episodes of urinary leakage in 20% and 16% of cases, respectively.

Conclusions: Patients with preoperative OAB are at a higher risk of developing more severe UI after RP, and the restoration of pre-surgery urinary continence is limited.

Keywords: bladder wall thickness; overactive bladder; radical prostatectomy; urinary bladder hypertrophy; urinary incontinence.