Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy

Nikolavsky, Dmitriy; Blakely, Stephen; Hadley, David; Knoll, Paul; Windsperger, Andrew P.; Terlecki, Ryan; Flynn, Brian J.

doi:10.1007/s11255-014-0816-9

Cited by 49 publications

(26 citation statements)

References 26 publications

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“…69 Nikolavsky et al retrospectively analyzed twelve cases of VUAS performed by a single surgeon over an 8-year period. 70 Surgical approaches were either abdominal (7), perineal (3) or abdominoperineal (2). They reported a 92% success and 75% incontinence rate.…”

Section: Urethral Reconstruction Outcomesmentioning

confidence: 99%

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Rocco

Zuckerman

2017

Therapeutic Advances in Urology

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Postprostatectomy vesicourethral anastomotic stenosis (VUAS) remains a challenging problem for both patient and urologist. Improved surgical techniques and perioperative identification and treatment of risk factors has led to a decline over the last several decades. High-level evidence to guide management is lacking, primarily relying on small retrospective studies and expert opinion. Endourologic therapies, including dilation and transurethral incision or resection with or without adjunct injection of scar modulators is considered first-line management. Recalcitrant VUAS requires surgical reconstruction of the vesicourethral anastomosis, and in poor surgical candidates, a chronic indwelling catheter or urinary diversion may be the only option. This review provides an update in the diagnosis and management of postprostatectomy VUAS.

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Section: Urethral Reconstruction Outcomesmentioning

confidence: 99%

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Rocco

Zuckerman

2017

Therapeutic Advances in Urology

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“…Comparative options such as bladder neck reconstruction have been shown to provide successful management in approximately 60-93% of patients. In addition, bladder neck reconstruction is a major complex procedure and has a significant risk of incontinence, resulting in the need for artificial urinary sphincter insertion [8,9,13]. Furthermore, urinary diversion is also a major procedure which whilst achieving urinary flow results in worse patient satisfaction outcomes.…”

Section: Discussionmentioning

confidence: 99%

Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

et al. 2019

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The incidence of vesicourethral anastomotic stenosis (VUAS) post radical prostatectomy varies from 1 to 26%. Current treatment can be challenging and includes a variety of different procedures. These range from endoscopic dilations to bladder neck reconstruction to urinary diversion. We investigated a 2-stage endoscopic treatment, using the thermo-expandable Memokath ® 045 bladder neck stent to manage patients with VUAS post radical prostatectomy. We retrospectively reviewed 30 patients, between 2013 and 2017, who underwent a Memokath ® 045 stent insertion following failed primary treatment (dilation and clean intermittent catheterisation) for VUAS. The mean interval time between prostatectomy and Memokath ® 045 stent insertion was 13 months. The mean follow-up time was 3.6 years with all patients having a minimum of 12-month follow-up. All patients had two previous attempts at endoscopic dilatation with or without incision and a trial of clean intermittent catheterisation. During stage 1, the anastomotic stricture is dilated/incised to diameter of 30 Fr, the stricture length is measured, and a catheter is left in situ. One to 2 weeks later, post haemostasis and healing, an appropriately sized Memokath ® 045 stent is inserted. The stent is then removed 1-year post-op. Our series of patients had a median age of 62 (54-72). Most patients (26) had a robot-assisted radical prostatectomy (RARP) or salvage procedure. Results showed improvement in IPSS scores, IPSS quality of life scores, Q max and PVR after the Memokath ® 045 stent was removed compared to pre-operation. With a minimum of 12 months post stent removal, 93% of patients were fully continent, whilst 7% of patients were socially continent. 2 (7%) patients had their stents removed and not replaced due to re-stricturing and stone formation. However, no urinary tract infections, stricture recurrence or urinary retention was observed in the rest of the cohort (93%). Overall, the Memokath ® 045 stent was successful in treating 93% of our patients with VUAS. Our series had minimal complications that were managed with conservative measures and in three patients' re-operation was needed. In conclusion, the Memokath ® 045 stent is a minimally invasive technique with faster recovery time compared to other techniques such as bladder neck reconstruction or urinary diversion. Additionally, it provides superior patency results compared to other techniques such as bladder neck incision and injection of Mitomycin C. Therefore, this management option should be considered in the management of VUAS.

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“…There were no AUS erosions in the 9 patients whom underwent placement at median follow up of 79 months ( 25 ). In another study, amongst 12 men who had undergone RP, abdominal repair was performed in seven with a median follow up of 46 months (range, 14–120 months), 92% patency was achieved ( 26 ). Retropubic re-anastomosis utilizing fasciocutaneous flaps, free graft urethroplasty with rectus muscle flap or anterior bladder tube with omental pedicle flap have been described and these techniques depend on expertise and surgical team experience, prior interventions, and degree of scar tissue encountered ( 44 ).…”

Section: Surgical Reconstruction Of the Bladder Neck—pure Abdominal Amentioning

confidence: 99%

Posterior urethral stenosis after prostate cancer treatment: contemporary options for definitive management

Kahokehr

Peterson

Lentz

2018

Transl. Androl. Urol.

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Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy

Abstract: In experienced hands, VUAR can restore durable patency for men afflicted with outlet stenosis after RP. Despite anatomic restoration, incontinence is likely.

Cited by 49 publications

References 26 publications

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

Posterior urethral stenosis after prostate cancer treatment: contemporary options for definitive management

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