Pd44-02 Lessons Learned From 48 Surgical Procedures for the Treatment of Urethrovesical Anastomotic Stenosis After Radical Prostatectomy.

Cavalcanti, André; Trujillo, Carlos Felipe; Almeida, Henrique; Heins, Felipe; Campos, Gabriel; Rodrigues, Bruno

doi:10.1016/j.juro.2016.02.1794

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“…Recently, Cavalcanti et al described a series of 48 patients with VUAS addressed by perineal approach. Twenty four of them (50%) presented UI (20). In addition, Ivaz et al, stated that all patients must be counselled that this will almost certainly be a two - stage reconstruction, the first to unblock them by revision of the vesicourethral anastomosis and then secondly to implant an artificial urinary sphincter for the almost inevitable sphincter weakness incontinence following unobstruction (16).…”

Section: Discussionmentioning

confidence: 99%

“…AUS is considered the gold standard for the treatment of UI after VUAS re - anastomosis by perineal approach. Despite the utility of the AUS, it is well known the association with complications and urinary incontinence post implantation vary between 12 and 40% (20-25). Recently, successful implantation (17 / 23 patients) has been reported with AUS for UI after perineal approach (15).…”

Section: Discussionmentioning

confidence: 99%

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Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy

et al. 2019

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Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 – 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 – 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. Conclusion: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.

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Section: Discussionmentioning

confidence: 99%