title: The Patient Burden of Bladder Outlet Obstruction after Prostate Cancer Treatment.
abstract: OBJECTIVE
  Bladder outlet obstruction after prostate cancer therapy imposes a significant burden on health and quality of life in men. Our objective was to describe the burden of bladder outlet obstruction after prostate cancer therapy by detailing the type of procedures performed and how often those procedures were repeated in men with recurrent bladder outlet obstruction.
  
  
  METHODS
  Using SEER (Surveillance, Epidemiology and End Results)-Medicare linked data from 1992 to 2007 with followup through 2009 we identified 12,676 men who underwent at least 1 bladder outlet obstruction procedure after prostate cancer therapy, including external beam radiotherapy in 3,994, brachytherapy in 1,485, brachytherapy plus external beam radiotherapy in 1,847, radical prostatectomy in 4,736, radical prostatectomy plus external beam radiotherapy in 369 and cryotherapy in 245. Histogram, incidence rates and Cox proportional hazards models with repeat events analysis were done to describe the burden of repeat bladder outlet obstruction treatments stratified by prostate cancer therapy type. We describe the type of bladder outlet obstruction surgery grouped by level of invasiveness.
  
  
  RESULTS
  At a median followup of 8.8 years 44.6% of men underwent 2 or more bladder outlet obstruction procedures. Compared to men who underwent radical prostatectomy those treated with brachytherapy and brachytherapy plus external beam radiotherapy were at increased adjusted risk for repeat bladder outlet obstruction treatment (HR 1.2 and 1.32, respectively, each p <0.05). After stricture incision the men treated with radical prostatectomy or radical prostatectomy plus external beam radiotherapy were most likely to undergo dilation at a rate of 34.7% to 35.0%. Stricture resection/ablation was more common after brachytherapy, external beam radiotherapy or brachytherapy plus external beam radiotherapy at a rate of 28.9% to 41.2%.
  
  
  CONCLUSIONS
  Almost half of the men with bladder outlet obstruction after prostate cancer therapy undergo more than 1 procedure. Furthermore men with bladder outlet obstruction after radiotherapy undergo more invasive endoscopic therapies and are at higher risk for multiple treatments than men with bladder outlet obstruction after radical prostatectomy.
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Daniel
authors.initials: D
authors.lastname: Liberman
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Jarosek
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota. Electronic address: selliott@umn.edu.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology / Q000209:etiology*
keywords: brachytherapy; prostatectomy; prostatic neoplasms; radiotherapy; urinary bladder neck obstruction