Moderate or severe LUTS is associated with increased recurrence of non - muscle - invasive urothelial carcinoma of the bladder

Abstract

Purpose: Non - muscle - invasive bladder cancer (NMIBC) can recur despite transurethral resection (TURBT) and adjuvant intravesical therapy. Tobacco products excreted in the urine are hypothesized to cause tumor - promoting effects on urothelial cells through direct contact. We determined if moderate or severe lower urinary tract symptoms (LUTS) (defined as International Prostate Symptom Score [IPSS] ≥ 8) was associated with increased tumor recurrence. Materials and Methods: We retrospectively identified 70 consecutive men initially diagnosed with NMIBC at our institution from 2010 – 2016. Means were compared with independent T - test and proportions with chi - square analysis. Multivariate logistic regression was performed to determine independent predictors of recurrence. Results: The majority of patients had Ta disease (58.6%) followed by T1 (28.6%) and Tis (12.9%). Forty - one (58.6%) patients had moderate or severe LUTS upon presentation within 30 days of initial TURBT with mean IPSS of 13.2 vs. 5.2 in the control group (p < 0.01). Biopsy - proven tumor recurrence occurred in 24 (34.3%) patients at mean follow-up of 31.7 months. Mean time to recurrence was 14.6 months. Moderate or severe LUTS was an independent predictor of tumor recurrence (odds ratio [OR]: 19.1, 95% confidence interval [CI]: 2.86 – 127; p = 0.002). Voiding or storage symptoms based on the IPSS did not independently correlate with tumor recurrence (p = 0.08 and p = 0.31, respectively) although total mean IPSS score did (OR: 1.26, 95% CI: 1.07 – 1.47, p = 0.005). Conclusions: The presence of moderate or severe LUTS may be an important prognostic factor in NMIBC. Patients with significant urinary symptoms could be monitored more aggressively due to higher recurrence risk.

Dysuria therapeutic agents as an independent prognostic factor for the primary recurrence of non-muscle invasive bladder cancer: a propensity score matching study

“… 18 Only one clinical study has reported the association between LUTS and the risk of recurrence of NMIBC using the International Prostate Symptom Score (IPSS). 19 In this study, the presence of moderate or severe LUTS in men at the time of diagnosis was associated with increased recurrence rates of NMIBC. Moreover, the p -value for benign prostatic hyperplasia medications between recurrence and non-recurrence groups was 0.09, indicating a slightly significant difference.…”

“…The number of patients in their study was 70, and the statistical power was low. 19 However, in our study, the number of patients was 162. Therefore, our investigation might have more strongly reflected the impact of difficult urination symptoms in NMIBC.…”

Prognostic Value of Prostate Volume in Non-muscle Invasive Bladder Cancer

“…9 A recent study reported that moderate to severe lower urinary tract symptoms (LUTSs) were associated with poor prognosis of NMIBC. 15 It has also been reported that the International Prostate Symptom Score was a signi cant predictor of recurrence of NMIBC (odds ratio = 1.26, p = 0.005). LUTSs are commonly associated with bladder outlet obstruction (BOO), which is often caused by benign prostatic enlargement.…”

A prospective study on the association between post-voiding residual volume and quality of life during bacille Calmette-Guérin (BCG) instillation therapy for non–muscle-invasive bladder cancer

“…16,17 Most recently, Lunney and colleagues reported an association between dysuria and the recurrence risk of NMIBC. 11 They conducted a retrospective survey of NMIBC recurrence using question indicators and concluded that the presence of moderate or severe LUTS may be an important prognostic factor for NMIBC. However, to our knowledge, no studies have investigated the association between urination status and change in QOL due to BCG therapy.…”

“…A recent study reported that patients with moderate or severe lower urinary tract symptoms (LUTS) have a high recurrence rate of NMIBC. 11 Based on this result, we hypothesised that the volume of residual urine might affect the efficacy of BCG therapy and the incidence of complications because low bladder clearance might increase the exposure time to BCG.…”