MP14-16 INCREASED PROSTATE SIZE AND HISTORY OF PREOPERATIVE VOIDING DYSFUNCTION ASSOCIATED WITH GREATER URINARY TOXICITY AFTER POST-PROSTATECTOMY ADJUVANT OR SALVAGE RADIATION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2016MP14-16 INCREASED PROSTATE SIZE AND HISTORY OF PREOPERATIVE VOIDING DYSFUNCTION ASSOCIATED WITH GREATER URINARY TOXICITY AFTER POST-PROSTATECTOMY ADJUVANT OR SALVAGE RADIATION Juan Guzman and Ricardo Sanchez-Ortiz Juan GuzmanJuan Guzman More articles by this author and Ricardo Sanchez-OrtizRicardo Sanchez-Ortiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2519AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Animal models using the rabbit bladder have shown that outlet obstruction is associated with bladder fibrosis and diminished aerobic metabolism. Given that genitourinary toxicity in men undergoing radiation therapy (RT) after radical prostatectomy (RP) is related to ischemia, we set out to correlate the relationship between clinical factors affecting bladder circulation and urinary complications after RT. METHODS Patients with a history of postoperative (postop) RT were identified from a database of 542 consecutive men who underwent RP by a single surgeon. Indications included positive margins, pT3, or a serum PSA ≥ 0.2. All were continent and waited ≥ 6 months before RT. Of 508 patients with ≥ 6 months (mo.) follow-up, 50 received adjuvant (3.3%, 17/508) or salvage (6.5%, 33/508) intensity modulated RT (median dose of 69 Gy), with 15.1% (5/33) receiving androgen ablation in the salvage group. Urinary complications were classified using the Clavien-Dindo system. SPSS was used for statistical analysis. RESULTS After a median follow-up of 37.9 mo., transient incontinence developed in 1 patient (2%) (Clavien-Dindo grade II), and permanent incontinence in 3 men (6%), one managed medically (grade II), and the others with a sling and an artificial sphincter, respectively (grade III). Three patients (6%) developed bladder neck scars requiring incision. No urothelial malignancies were identified. Twenty percent of patients (10/50) developed hematuria requiring fulguration (grade III) (5 salvage and 5 adjuvant RT) followed by hyperbaric oxygen therapy in 3 patients. Patients with hematuria had higher preop International Prostate Symptom Scores (IPSS) (15.5 vs. 6.5, p<0.01) and larger prostates (51.7 vs. 39.3 g, p<0.01) compared with those without. Seventy five percent of patients with prostates ≥ 60 g developed hematuria compared with 9.5% of those with smaller glands (p<0.001). Diabetic patients showed a trend for hematuria (25% vs. 19.5%) and incontinence (12.5% vs. 7.3%) but this was not significant (only 8/50 radiated patients had DM). Urinary complications did not correlate with age, surgery type (80% robotic), salvage vs. adjuvant RT, body-mass index, smoking, hyperlipidemia, or hypertension. CONCLUSIONS Our data show that grade III urinary complications may develop in up to 30% of patients treated with RT after RP. Gross hematuria was 3 times more common (20%) than incontinence (6%) or strictures (6%) and predominantly affected men with preop voiding dysfunction or large prostates (≥ 60 g). The association between preoperative gland size and complications of RT in the postprostatectomy setting warrants validation with a larger cohort of patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e150 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Juan Guzman More articles by this author Ricardo Sanchez-Ortiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...