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

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0068


ORIGINAL ARTICLE

Austin Lunney 1, Allan Haynes 1, Pranav Sharma 1
1 Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA

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.

Keywords: Urinary Bladder Neoplasms; Lower Urinary Tract Symptoms; Carcinoma, Transitional Cell

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