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Do Drugs Work for ΟΑΒ Following Prostate Cancer Surgery
Vasileios Sakalis1, Anastasia Gkotsi1
1Agios Pavlos, General Hospital of Thessaloniki, Urology, Greece.
Abstract:
There is evidence that post-radical prostatectomy (post-RP) incontinence is not just the insufficiency of the external urethral sphincter mechanism. Up to a third of men with post-RP incontinence suffer from bladder dysfunction, namely overactive bladder (OAB). OAB is a complex symptom syndrome with poorly defined pathophysiology. It causes a significant burden to patients, negatively affects the quality of their life and its management might be difficult and challenging. The incidence of post-RP OAB ranges from 15.2 to 37.8%. The aetiology is multifactorial and includes the partial decentralization of the bladder, the detrusor underactivity, the bladder outlet obstruction and the co-existence with stress urinary incontinence (SUI). Post-RP SUI may lead to defunctionalized bladder and activation of urethrovesical reflex which further deteriorate post-RP continence. The diagnostic work-up of men with post-RP OAB should aim to identify potential aetiologic factors and personalize the treatment accordingly. Until now, there is no robust data from literature with regards to post-RP OAB management. It seems that anticholinergics and PDE5 inhibitors are effective in improving OAB parameters.
Insights
Over a third of men experience overactive bladder (OAB) after radical prostatectomy, impacting quality of life. Management is challenging, but some medications show promise for improving OAB symptoms.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Post-radical prostatectomy (post-RP) incontinence is common.
- A significant portion of men with post-RP incontinence also exhibit overactive bladder (OAB) symptoms.
- The pathophysiology of OAB post-RP is complex and not fully understood.
Purpose of the Study:
- To review the incidence, etiology, and management of overactive bladder (OAB) in men following radical prostatectomy (RP).
- To highlight the challenges in diagnosing and treating post-RP OAB.
- To summarize current understanding and potential therapeutic approaches for post-RP OAB.
Main Methods:
- Literature review of studies investigating post-radical prostatectomy incontinence and overactive bladder.
- Analysis of the multifactorial etiology of OAB in the post-prostatectomy population.
- Evaluation of diagnostic work-up strategies and treatment options.
Main Results:
- The incidence of OAB post-RP ranges from 15.2% to 37.8%.
- Potential causes include bladder decentralization, detrusor underactivity, outlet obstruction, and co-existing stress urinary incontinence (SUI).
- Anticholinergics and PDE5 inhibitors appear effective in improving OAB parameters.
Conclusions:
- Overactive bladder (OAB) is a significant issue for men after radical prostatectomy (RP), contributing to incontinence.
- Personalized diagnosis and treatment are crucial, considering the multifactorial nature of post-RP OAB.
- Further research is needed for robust management guidelines, though current options like anticholinergics and PDE5 inhibitors show potential.