1018 Predictors of bladder neck contracture following radical prostatectomy

Abstract

INTRODUCTION AND OBJECTIVES: Bladder neck contracture (BNC) after radical prostatectomy (RP) is a common yet understudied complication with significant adverse quality of life implications. Here we identify patient groups that are at highest risk for BNC after RP. METHODS: Years 1987 to 2013 of a prospectively maintained single institution RP registry were queried for patients with and without BNC. Those with prior TURP or radiotherapy were excluded. Descriptive statistics, univariate and multivariate logistic regressions (with forward stepwise entry), and receiver operating curves were employed to identify predictors of BNC. The impact of BNC on functional and oncologic outcomes was then assessed. RESULTS: Out of 17,954 men with a mean follow up of 10 years after RP, 858 (4.8%) developed BNC. Men with BNC had higher risk features than those without BNC: cT3/4 (10.3% vs 5.3%, p<0.001), biopsy Gleason score 8-10 (10.4% vs 7.3%, p<0.001), and higher PSA (11.9 vs 8.6, p<0.001). Multivariate logistic regression modeling identified several significant associations with BNC development after RP (Table 1). Importantly, BNC independently increases the risk of 1 or more incontinence pads per day at 1 year after RP (OR 1.755, 95% CI 1.405-2.191, p<0.001). However, the occurrence of BNC was not associated with 20-year oncologic outcomes. CONCLUSIONS: About 5% of patients will develop a BNC after RP and this incidence has declined over time. Nevertheless, the presence of a BNC is independently associated with a 75% increased risk of urinary incontinence following RP. Accordingly, we uncovered several novel risk factors for BNC, including: greater BMI, prostate volume, advanced pT stage, urine leak, early UTI, need for transfusion, and lack of nerve sparing. Validation of these findings is warranted to help design interventions that may reduce the incidence of BNC even further.