Skip to main content

Advertisement

SpringerLink
Log in

Management of Overactive Bladder Symptoms After Radical Prostatectomy

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Post-prostatectomy overactive bladder (OAB) is a common and challenging condition to manage. The aim of the present report was to review the recent evidences regarding OAB symptoms that develop in men after prostatectomy and how to manage them.

Recent Findings

The prevalence of OAB after radical prostatectomy may range from 15.2 to 37.8%. Recent studies have highlighted the role of the urethrogenic mechanism (facilitation of the urethrovesical reflex due to stress urinary incontinence (SUI)) in the genesis of post-prostatectomy OAB in a significant proportion of patients. Several other pathophysiological factors such as iatrogenic decentralization of the bladder, defunctionalized bladder due to severe SUI, detrusor underactivity, or bladder outlet obstruction might be involved. The evaluation should aim to identify the underlying mechanism to tailor the treatment, which could range from SUI surgery, to fixing a urethral stricture, improving bladder emptying or using the conventional spectrum of OAB therapies. There is a paucity of data for OAB therapies specific to post-prostatectomy patients, with the exception of solifenacin, tolterodine, and botulinum toxin. There is currently no data on how preoperative management or surgical technique may prevent post-prostatectomy OAB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    Article  Google Scholar 

  2. Trama A, Botta L, Nicolai N, Rossi PG, Contiero P, Fusco M, et al. Prostate cancer changes in clinical presentation and treatments in two decades: an Italian population-based study. Eur J Cancer. 2016;67:91–8.

    Article  Google Scholar 

  3. Chen J, Oromendia C, Halpern JA, Ballman KV. National trends in management of localized prostate cancer : a population based analysis 2004-2013. Prostate. 2018;78(7):512–20.

    Article  Google Scholar 

  4. Capogrosso P, Salonia A, Briganti A, Montorsi F. Postprostatectomy erectile dysfunction: a review. World J Mens Health. 2016;34(2):73–88.

    Article  Google Scholar 

  5. Trofimenko V, Myers JB, Brant WO. Post-prostatectomy incontinence: how common and bothersome is it really? Sex Med Rev. 2017;5(4):536–43.

    Article  Google Scholar 

  6. Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A. Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol. 2017;71(6):936–44.

    Article  Google Scholar 

  7. • Matsukawa Y, Yoshino Y, Ishida S, et al. De novo overactive bladder after robot-assisted laparoscopic radical prostatectomy. Neurourol Urodyn. 2018. https://doi.org/10.1002/nau.23556 Prospective series identifying low preoperative maximum urethral closure pressure (MUCP) and greater decrease in MUCP postoperatively as significant predictors of urgency after radical prostatectomy strengthening the idea of an urethrogenic mechanism in the pathophysiology of post-prostatectomy OAB.

    Article  Google Scholar 

  8. • Hosier GW, Tennankore KK, Himmelman JG, Gajewski J, Cox AR. Overactive bladder and Storage Lower Urinary Tract Symptoms Following Radical Prostatectomy. Urology. 2016;94:193–7 Retrospective series highlighting adjuvant or salvage radiotherapy as a major risk factor of post-prostatectomy OAB.

    Article  Google Scholar 

  9. Aning JJ, MacKenzie KR, Fabricius M, et al. Detailed analysis of patient-reported lower urinary tract symptoms and effect on quality of life after robotic radical prostatectomy. Urol Oncol. 2018; in press.

  10. Boettcher M, Haselhuhn A, Jakse G, Brehmer B, Kirschner-Hermanns R. Overactive bladder syndrome: an underestimated long-term problem after treatment of patients with localized prostate cancer? BJU Int. 2012;109(12):1824–30.

    Article  Google Scholar 

  11. Slova D, Lepor H. The short-term and long-term effects of radical prostatectomy on lower urinary tract symptoms. J Urol. 2007;178(6):2397–400.

    Article  Google Scholar 

  12. Sebesta M, Cespedes RD, Luhman E, Optenberg S, Thompson IM. Questionnaire-based outcomes of urinary incontinence and satisfaction rates after radical prostatectomy in a national study population. Urology. 2002;60(6):1055–8.

    Article  Google Scholar 

  13. Song C, Lee J, Hong JH, Choo MS, Kim CS, Ahn H. Urodynamic interpretation of changing bladder function and voiding pattern after radical prostatectomy: a long-term follow-up. BJU Int. 2010;106(5):681–6.

    Article  Google Scholar 

  14. • Pastore AL, Palleschi G, Illiano E, Zucchi A, Carbone A, Costantini E. The role of detrusor overactivity in urinary incontinence after radical prostatectomy: a systematic review. Minerva Urol Nefrol. 2017;69(3):234–41 Systematic review reporting a prevalence of detrusor overactivity (DO) after radical prostatectomy ranging from 3 to 63% and identifying preoperative DO as the main risk factor of postoperative DO.

    PubMed  Google Scholar 

  15. Chapple C. Chapter 2: pathophysiology of neurogenic detrusor overactivity and the symptom complex of “overactive bladder”. Neurourol Urodyn. 2014;33(Suppl 3):S6–13.

    Article  Google Scholar 

  16. Hanna-Mitchell AT, Kashyap M, Chan WV, Andersson KE, Tannenbaum C. Pathophysiology of idiopathic overactive bladder and the success of treatment: a systematic review from ICI-RS 2013. Neurourol Urodyn. 2014;33(5):611–7.

    Article  CAS  Google Scholar 

  17. Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175(1):191–4.

    Article  CAS  Google Scholar 

  18. Porena M, Mearini E, Mearini L, Vianello A, Giannantoni A. Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency. Eur Urol. 2007;52(1):38–45.

    Article  Google Scholar 

  19. Ficazzola MA, Nitti VW. The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol. 1998;160(4):1317–20.

    Article  CAS  Google Scholar 

  20. Barrington FJF. The component reflexes of micturition in the cats, parts 1 and 2. Brain. 1931;54:177–88.

    Article  Google Scholar 

  21. Jung SY, Fraser MO, Ozawa H, et al. Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol. 1999;162(1):204–12.

    Article  CAS  Google Scholar 

  22. Shafik A, Shafik AA, El-Sibai O, et al. Role of positive urethrovesical feedback in vesical evacuation. The concept of a second micturition reflex: the urethrovesical reflex. World J Urol. 2003;21:167–70.

    Article  Google Scholar 

  23. Shafik A, el-Sibai O, Ahmed I. Effect of urethral dilation on vesical motor activity: identification of the urethrovesical reflex and its role in voiding. J Urol. 2003;169(3):1017–9.

    Article  Google Scholar 

  24. Hubeaux K, Deffieux X, Desseaux K, Verollet D, Damphousse M, Amarenco G. Stand up urgency: is this symptom related to a urethral mechanism? Prog Urol. 2012;22(8):475–81.

    Article  CAS  Google Scholar 

  25. Serels SR, Rackley RR, Appell RA. Surgical treatment for stress urinary incontinence associated with valsalva induced detrusor instability. J Urol. 2000;163(3):884–7.

    Article  CAS  Google Scholar 

  26. •• Haga N, Ogawa S, Yabe M, et al. Association between postoperative pelvic anatomic features on magnetic resonance imaging and lower tract urinary symptoms after radical prostatectomy. Urology. 2014;84(3):642–9 Series reporting an association between presence of urine in proximal urethra at rest on postoperative MRI and urgency after radical prostatectomy strengthening the idea of an urethrogenic mechanism in the pathophysiology of post-prostatectomy OAB.

    Article  Google Scholar 

  27. Neves Neto JF, Palomino Z, Mizuno Watanabe IK, et al. Pretransplant defunctionalized bladder-overrated condition? Neurourol Urodyn. 2018;in press. https://doi.org/10.1002/nau.23495.

    Article  Google Scholar 

  28. • Afraa TA, Campeau L, Mahfouz W, Corcos J. Urodynamic parameters evolution after artificial urinary sphincter implantation for post-radical prostatectomy incontinence with concomitant bladder dysfunction. Can J Urol. 2011;18(3):5695–8 Retrospective series showing complete resolution of detrusor overactivity and impaired bladder compliance after artificial urinary sphincter implantation in a vast majority of patients with post-prostatectomy incontinence suggesting artifactual defunctionalized bladder as an explanation of these urodynamic findings.

    PubMed  Google Scholar 

  29. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    Article  Google Scholar 

  30. • Chung DE, Dillon B, Kurta J, et al. Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors. Can Urol Assoc J. 2013;7:E33–7 Retrospective series reporting 41% of detrusor underactivity after radical prostatectomy.

    Article  Google Scholar 

  31. Uren AD, Cotterill N, Harding C, Hillary C, Chapple C, Klaver M, et al. Qualitative Exploration of the Patient Experience of Underactive Bladder. Eur Urol. 2017;72(3):402–7.

    Article  Google Scholar 

  32. Kim DK. Origin of urgency symptom in underactive bladder: commentary on “Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment”. 2015;Int Neurourol J, 19(4):293–4.

  33. Liberman D, Jarosek S, Virnig BA, Chu H, Elliott SP. The Patient Burden of Bladder Outlet Obstruction after Prostate Cancer Treatment. J Urol. 2016;195(5):1459–63.

    Article  Google Scholar 

  34. • Jarosek SL, Virnig BA, Chu H, Elliott SP. Propensity-weighted long-term risk of urinary adverse events after prostate cancer surgery, radiation, or both. Eur Urol. 2015;67(2):273–80 Population-based study showing a cumulative prevalence of 20.3% of urethral stricture 10 years after radical prostatectomy.

    Article  Google Scholar 

  35. Drake MJ, Kanai A, Bijos DA, Ikeda Y, Zabbarova I, Vahabi B, et al. The potential role of unregulated autonomous bladder micromotions in urinary storage and voiding dysfunction; overactive bladder and detrusor underactivity. BJU Int. 2017;119(1):22–9.

    Article  Google Scholar 

  36. Gacci M, Russo GI, De Nunzio C, et al. Meta-analysis of metabolic syndrome and prostate cancer. Prostate Cancer Prostatic Dis. 2017;20(2):146–55.

    Article  CAS  Google Scholar 

  37. Gacci M, Sebastianelli A, Salvi M, de Nunzio C, Tubaro A, Gravas S, et al. The impact of central obesity on storage luts and urinary incontinence after prostatic surgery. Curr Urol Rep. 2016;17(9):61.

    Article  Google Scholar 

  38. Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481–90.

    Article  CAS  Google Scholar 

  39. Ait Said K, Leroux Y, Menahem B, Doerfler A, Alves A, Tillou X. Effect of bariatric surgery on urinary and fecal incontinence: prospective analysis with 1-year follow-up. Surg Obes Relat Dis. 2017;13(2):305–12.

    Article  Google Scholar 

  40. Bill-Axelson A, Garmo H, Holmberg L, Johansson JE, Adami HO, Steineck G, et al. Long-term distress after radical prostatectomy versus watchful waiting in prostate cancer: a longitudinal study from the Scandinavian Prostate Cancer Group-4 randomized clinical trial. Eur Urol. 2013;64(6):920–8.

    Article  Google Scholar 

  41. Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder - a systematic review. J Psychosom Res. 2015;78(2):95–108.

    Article  Google Scholar 

  42. Ervandian M, Djurhuus JC, Høyer M, Graugaard-Jensen C, Borre M. Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy. Scand J Urol. 2018;52(1):20–6.

    Article  Google Scholar 

  43. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.

    Article  Google Scholar 

  44. Arcila-Ruiz M, Brucker BM. The role of urodynamics in post-prostatectomy incontinence. Curr Urol Rep. 2018;19(3):21.

    Article  Google Scholar 

  45. Tse V, King J, Dowling C, English S, Gray K, Millard R, et al. Conjoint Urological Society of Australia and New Zealand (USANZ) and Urogynaecological Society of Australasia (UGSA) Guidelines on the management of adult non-neurogenic overactive bladder. BJU Int. 2016;117(1):34–47.

    Article  Google Scholar 

  46. • Tienforti D, Sacco E, Marangi F, et al. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU Int. 2012;110(7):1004–10 Randomized controlled trial evidencing significant reduction of OAB symptoms at 3 and 6 months with a structured program of pelvic floor muscle training + biofeedback.

    Article  Google Scholar 

  47. • Lai HH, Boone TB. Implantation of artificial urinary sphincter in patients with post-prostatectomy incontinence, and preoperative overactive bladder and mixed symptoms. J Urol. 2011;185(6):2254–9 Retrospective series reporting complete resolution of OAB symptoms in 29% of patients with mixed urinary incontinence after radical prostatectomy.

    Article  Google Scholar 

  48. Yiou R, Bütow Z, Parisot J, Lingombet O, Augustin D, de la Taille A, et al. Update on 2-year outcomes of the TOMS™ transobturator male sling for the treatment of male stress urinary incontinence. Neurourol Urodyn. 2016;35(1):44–7.

    Article  Google Scholar 

  49. Sacco E, Gandi C, Vaccarella L, Recupero S, Racioppi M, Pinto F, et al. Titanized transobturator sling placement for male stress urinary incontinence using an inside-out single-incision technique: minimum 12-months follow-up study. Urology. 2018;115:144–50.

    Article  Google Scholar 

  50. Yiou R, Butow Z, Baron T, Salomon L, Audureau E. Adjustable continence therapy (ProACT™) after male sling failure for patients with post-radical prostatectomy urinary incontinence: a prospective study with one-year follow-up. World J Urol. 2015;33(9):1331–6.

    Article  Google Scholar 

  51. Cox A, Herschorn S. Management of the incontinent patient with a sphincteric stricture following radical prostatectomy. Curr Opin Urol. 2014;24(6):578–85.

    Article  Google Scholar 

  52. Radadia KD, Farber NJ, Shinder B, Polotti CF, Milas LJ, Tunuguntla HSGR. Management of postradical prostatectomy urinary incontinence: a review. Urology. 2018;113:13–9.

    Article  Google Scholar 

  53. • Cornu JN, Merlet B, Ciofu C, et al. Duloxetine for mild to moderate postprostatectomy incontinence: preliminary results of a randomised, placebo-controlled trial. Eur Urol. 2011;59(1):148–54 Placebo controlled randomized trial demonstrating efficacy of duloxetine in post-prostatectomy stress urinary incontinence but with no assessment of OAB symptoms.

    Article  CAS  Google Scholar 

  54. Filocamo MT, Li Marzi V, Del Popolo G, et al. Pharmacologic treatment in postprostatectomy stress urinary incontinence. Eur Urol. 2007;51(6):1559–64.

    Article  CAS  Google Scholar 

  55. Steers WD, Herschorn S, Kreder KJ, Moore K, Strohbehn K, Yalcin I, et al. Duloxetine compared with placebo for treating women with symptoms of overactive bladder. BJU Int. 2007;100(2):337–45.

    Article  CAS  Google Scholar 

  56. Burkhard F, Bosch J, Cruz F, et al. EAU guidelines on urinary incontinence 2018. Available at: http://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urinary-Incontinence-2018-large-text.pdf.

  57. Osterberg EC, Schulster M, Blaivas JG, Maganty A, Lee DJ, Purohit RS. Urethroplasty improves overactive bladder symptoms in men with anterior urethral strictures. Urology. 2016;93:208–12.

    Article  Google Scholar 

  58. Hampson LA, Elliott SP, Erickson BA, Vanni AJ, Myers JB, McClung C, et al. Multicenter analysis of urinary urgency and urge incontinence in patients with anterior urethral stricture disease before and after urethroplasty. J Urol. 2016;196(6):1700–5.

    Article  Google Scholar 

  59. Gani J, Hennessey D. The underactive bladder: diagnosis and surgical treatment options. Transl Androl Urol. 2017;6(Suppl 2):S186–95.

    Article  Google Scholar 

  60. Newman DK, Guzzo T, Lee D, Jayadevappa R. An evidence-based strategy for the conservative management of the male patient with incontinence. Curr Opin Urol. 2014;24(6):553–9.

    Article  Google Scholar 

  61. Yang SW, Na YG, Song KH, Shin JH, Chang YS, Park JM, et al. Lower urinary tract symptoms and efficacy of anticholinergic drugs in patients remaining disease-free after radical retropubic prostatectomy. Urol J. 2016;13(3):2684–9.

    PubMed  Google Scholar 

  62. Liss MA, Morales B, Skarecky D, Ahlering TE. Phase 1 clinical trial of Vesicare™ (solifenacin) in the treatment of urinary incontinence after radical prostatectomy. J Endourol. 2014;28(10):1241–5.

    Article  Google Scholar 

  63. Mitropoulos D, Papadoukakis S, Zervas A, Alamanis C, Giannopoulos A. Efficacy of tolterodine in preventing urge incontinence immediately after prostatectomy. Int Urol Nephrol. 2006;38(2):263–8.

    Article  CAS  Google Scholar 

  64. Honda M, Kawamoto B, Morizane S, Hikita K, Muraoka K, Sejima T, et al. Impact of postoperative phosphodiesterase type 5 inhibitor treatment on lower urinary tract symptoms after robot-assisted radical prostatectomy: a longitudinal study. Scand J Urol. 2017;51(1):33–7.

    Article  CAS  Google Scholar 

  65. • Habashy D, Losco G, Tse V, Collins R, Chan L. Botulinum toxin (OnabotulinumtoxinA) in the male non-neurogenic overactive bladder: clinical and quality of life outcomes. BJU Int. 2015;116 Suppl 3:61–5 Only published series assessing a third-line OAB therapy in the post-prostatectomy setting and showing 45% of urgency incontinence resolution after onabotulinum toxin A intradetrusor injections.

    Article  Google Scholar 

  66. Shim M, Kim J, Park S, Choi SK, Lee SM, Huh KO, et al. The therapeutic effect of solifenacin succinate on the recovery from voiding dysfunction after radicalprostatectomy in men with clinically localized prostate cancer: a prospective, randomized, controlled study. Urology. 2015;85(5):1123–9.

    Article  Google Scholar 

  67. • Bianco FJ, Albala DM, Belkoff LH, et al. A randomized, double-blind, solifenacin succinate versus placebo control, phase 4, multicenter study evaluating urinary continence after robotic assisted radical prostatectomy. J Urol. 2015;193(4):1305–10 Large phase 4 randomized placebo controlled trial showing earlier return to continence after radical prostatectomy with solifenacin 5 mg.

    Article  CAS  Google Scholar 

  68. Nitti VW, Chapple CR, Walters C, Blauwet MB, Herschorn S, Milsom I, et al. Safety and tolerability of the β3 -adrenoceptor agonist mirabegron, for the treatment of overactive bladder: results of a prospective pooled analysis of three 12-week randomised phase III trials and of a 1-year randomised phase III trial. Int J Clin Pract. 2014;68(8):972–85.

    Article  CAS  Google Scholar 

  69. Michel MC, Gravas S. Safety and tolerability of β3-adrenoceptor agonists in the treatment of overactive bladder syndrome - insight from transcriptosome and experimental studies. Expert Opin Drug Saf. 2016;15(5):647–57.

    CAS  PubMed  Google Scholar 

  70. Chen H, Wang F, Yu Z, et al. Efficacy of daily low-dose tadalafil for treating overactive bladder: results of a randomized, double-blind, placebo-controlled trial. Urology. 2017;100:59–64.

    Article  Google Scholar 

  71. Cruz F, Nitti V. Chapter 5: Clinical data in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). Neurourol Urodyn. 2014;33(Suppl 3):S26–31.

    Article  Google Scholar 

  72. Hoffman D, Enemchukwu E, Nitti VW. Predictors of urinary retention in male patients receiving intradetrusor botulinum toxin injections. J Urol. 2016;197(4):e749.

    Article  Google Scholar 

  73. Hennessey DB, Hoag N, Gani J. Sacral neuromodulation for detrusor hyperactivity with impaired contractility. Neurourol Urodyn. 2017;36(8):2117–22.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Rennes, Service d’Urologie, 2 rue Henri Le Guilloux, 35000, Rennes, France

    Benoit Peyronnet

  2. Department of Urology, New York University, New York, NY, USA

    Benjamin M. Brucker

Authors
  1. Benoit Peyronnet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin M. Brucker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benoit Peyronnet.

Ethics declarations

Conflicts of Interest

Benoit Peyronnet is a consultant for Allergan, Medtronic, Astellas and Boston Scientific, and an investigator for Ipsen.

Benjamin Brucker is a consultant for Allergan, Watkins Conti, Avadel, Serenity, and an investigator for Ipsen and Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peyronnet, B., Brucker, B.M. Management of Overactive Bladder Symptoms After Radical Prostatectomy. Curr Urol Rep 19, 95 (2018). https://doi.org/10.1007/s11934-018-0847-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-018-0847-3

Keywords

Search

Navigation