Voiding Dysfunction Among Older Adults With Non-Muscle Invasive Bladder Cancer: Incidence and Predictors of Treatment...

Non-muscle invasive bladder cancer (NMIBC) is a chronic disease with a lifelong treatment burden that may cause substantial urinary morbidity. Such quality-of-life changes remain understudied. We therefore evaluated the incidence and predictors of treatment for overactive bladder (OAB) among older adults following diagnosis of NMIBC.

We identified adults aged 66-89 years with newly diagnosed NMIBC from 2007 to 2017 in the linked SEER-Medicare database. We examined the incidence of treatment initiation for OAB following initial transurethral resection of bladder tumor (TURBT) and evaluated associations with baseline characteristics using Cox regression.

We identified 9,819 patients, of whom 68% had Ta disease, 29% had T1 disease, and 4% had CIS. Within the first 12 months of TURBT, 7% of patients received treatment for OAB, and this increased to 15% of patients at 5 years. In the first year, the most utilized therapies were anticholinergic medications (early 3.72%, late 2.74%) and beta-3 agonists (early 0.11%, late 0.32%), while procedural OAB therapy utilization was rare (0.2%). On multivariable analysis, female gender (HR 1.26, 95% CI 1.11-1.42), congestive heart failure (HR 1.21, 95% CI 1.03-1.43), and T1 tumor stage (HR 1.27, 95% CI 1.12-1.44 vs. Ta) were independently associated with an increased risk of OAB treatment.

The incidence of OAB requiring treatment among patients with NMIBC is substantial, with approximately one in six patients receiving treatment by 5 years after diagnosis. Predictive clinicopathologic features for OAB treatment-including, sex, high-risk tumor features, and repeat TURBT-may be useful for clinical counseling.