Deep lateral transurethral incision for vesicourethral anastomotic stenosis after radical prostatectomy

Shinchi, Masayuki; Horiguchi, Akio; Ojima, Kenichiro; Hirano, Yusuke; Takahashi, Eiji; Kimura, Fumihiro; Ito, Keiichi

doi:10.1111/iju.14650

Cited by 7 publications

(6 citation statements)

References 25 publications

(85 reference statements)

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“…The risk of bias assessment was unfavourable for a large majority of studies regarding the measurement of the condition (utilisation of valid method, measurement in a standard, reliable way; Fig. 3 [1,19,27–64]).…”

Section: Resultsmentioning

confidence: 99%

Post‐prostatectomy anastomotic stenosis: systematic review and meta‐analysis of endoscopic treatment

Delchet,

Nourredine,

González Serrano

et al. 2023

BJU International

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ObjectiveTo perform a systematic review and meta‐analysis of endoscopic procedures for treating vesico‐urethral anastomotic stenosis (VUAS) after prostatectomy, as initial VUAS management remains unclear.MethodsA search of the MEDLINE database, the Cochrane database, and clinicaltrials.gov was performed (last search February 2023) using the following query: ([‘bladder neck’ OR ‘vesicourethral anastomotic’ OR ‘anastomotic’] AND [‘stricture’ OR ‘stenosis’ OR ‘contracture’] AND ‘prostatectomy’). The primary outcome was the success rate of VUAS treatment, defined by the proportion (%) of patients without VUAS recurrence at the end of follow‐up.ResultsThe literature search identified 420 studies. After the screening, 78 reports were assessed for eligibility, and 40 studies were included in the review. The pooled characteristics of the 40 studies provided a total of 1452 patients, with a median (interquartile range [IQR]) follow‐up of 23.7 (13–32) months and age of 66 (64–68) years. The overall success rate (95% confidence interval [CI]) of all endoscopic procedures for VUAS treatment was 72.8% (64.4%–79.9%). Meta‐regression models showed a negative influence of radiotherapy on the overall success rate (P = 0.012). After trim‐and‐fill (addition of 10 studies), the corrected overall success rate (95% CI) was 62.9% (53.6%–71.4%).ConclusionThis first meta‐analysis of endoscopic treatment success rate after VUAS reported an overall success rate of 72.8%, lowered to 62.9% after correcting for significant publication bias. This study also highlighted the need for a more thorough reporting of post‐prostatectomy VUAS data to understand the treatment pathway and provide higher‐quality evidence‐based care.

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Section: Resultsmentioning

confidence: 99%

Post‐prostatectomy anastomotic stenosis: systematic review and meta‐analysis of endoscopic treatment

Delchet,

Nourredine,

González Serrano

et al. 2023

BJU International

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“…2a ), and DVIU was performed using a hot knife at the 3 and 9 o'clock positions. 4 Six months after DVIU, perineal discomfort and left hip pains were observed. PBO and USF extending from the VUAS site to the pubic symphysis were detected on MRI (Fig.…”

Section: Case Reportmentioning

confidence: 99%

“…VUAS was identified 2 years after RT (Fig. 2a), and DVIU was performed using a hot knife at the 3 and 9 o'clock positions 4 . Six months after DVIU, perineal discomfort and left hip pains were observed.…”

Section: Case Reportmentioning

confidence: 99%

Urosymphyseal fistula development following treatment for radiation‐induced urethral stenosis in three patients with prostate cancer

Takekawa,

Horiguchi,

Ojima

et al. 2023

IJU Case Reports

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IntroductionUrosymphyseal fistula is a rare and devastating complication that develops after radiation therapy for prostate cancer and is often triggered by the treatment of radiation‐induced urethral stenosis. Here, we report our experience with urosymphyseal fistulas in three patients with prostate cancer.Case presentationThree patients with prostate cancer developed urethral stenosis after radiotherapy. The management of urethral stenosis was suprapubic tube placement in case 1, direct vision internal urethrotomy in case 2, and excision with primary anastomosis in case 3. All patients presented with severe suprapubic or thigh pain or both. Urosymphyseal fistulas were detected on magnetic resonance imaging. Conservative treatment was unsuccessful, and all patients required debridement of the necrotic pubic symphysis and simple cystectomy. In cases 1 and 2, ileal conduit urinary diversion was performed.ConclusionUrologists need to be aware that urosymphyseal fistulas can occur in irradiated patients with prostate cancer, especially after urethral stenosis treatment.

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“…EAU guidelines highlight rates of 0-11%; however, some studies have reported it to be as high as 88%. 41 Therefore, patient expectations need to be managed prior to the initiation of any treatment. Appropriate counselling regarding the risks of recurrence, potential complications and multiple procedures is key.…”

Section: Research and Reports In Urology 2023:15mentioning

confidence: 99%

“…Shinchi et al reported the first-time success rate of deep BNI approach as 81.4%, but this was matched by an equally high percentage of de novo incontinence. 41 As such, albeit there is evidence to support performing deep BNI down to fat it does not increase the success rate significantly enough to justify the additional risks. 41 These outcomes are also not further improved by combination of simultaneous balloon dilatation, as patency rates for this are similar, and range from 72% to 81% after a single procedure.…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

Refractory Bladder Neck Contracture (BNC) After Radical Prostatectomy: Prevalence, Impact and Management Challenges

Uguzova,

Beisland,

Honoré

et al. 2023

RRU

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Bladder neck contracture is a recognised complication associated with radical prostatectomy. The management can be challenging, especially when refractory to initial intervention strategies. For the patient, the burden of disease is high and continence status cannot be overlooked. This review serves to provide an overview of the management of this recognised clinical pathology. Consideration needs to be given to minimally invasive approaches such as endoscopic incision, injectables, implantable devices as well as major reconstructive surgery where the condition persists. For the latter, this can involve open and robotic surgery as well as use of grafts and artificial sphincter surgery. These elements underline the need for a tailored and a patient centred approach.

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Deep lateral transurethral incision for vesicourethral anastomotic stenosis after radical prostatectomy

Cited by 7 publications

References 25 publications

Post‐prostatectomy anastomotic stenosis: systematic review and meta‐analysis of endoscopic treatment

Post‐prostatectomy anastomotic stenosis: systematic review and meta‐analysis of endoscopic treatment

Urosymphyseal fistula development following treatment for radiation‐induced urethral stenosis in three patients with prostate cancer

Refractory Bladder Neck Contracture (BNC) After Radical Prostatectomy: Prevalence, Impact and Management Challenges

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