Postprostatectomy Anastomosis Stenosis: A Systematic Review

Song, Joseph; Eswara, Jairam R.; Brandes, Steven B.

doi:10.1016/j.urology.2015.02.073

Cited by 13 publications

(14 citation statements)

References 42 publications

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“…Repeat procedures and more invasive techniques may result in higher incontinence rates. 73 Deep incision, transurethral resection and open repair of VUAS appear to consistently have the highest rates of incontinence. Therefore, it is important to counsel patients about the possibility that the cost of maintaining an open VUA may be incontinence.…”

Section: Concurrent Proceduresmentioning

confidence: 97%

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: Concurrent Proceduresmentioning

confidence: 97%

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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“…Urethral anastomosis stenosis was observed in 1.1% of patients in the EP group and 2.6% of patients in the TP group. The incidence of strictures of the vesico-urethral anastomosis after radical prostatectomy has been reported to range from 0.5 to 32%, with most occurring within 5 months of radical prostatectomy [ 27 – 29 ]. Thus, the rate of anastomosis stenosis in our study was lower than those in the literature and the follow-up duration of our study was sufficient to evaluate the rate of anastomosis stenosis after RARP.…”

Section: Discussionmentioning

confidence: 99%

New steps of robot-assisted radical prostatectomy using the extraperitoneal approach: a propensity-score matched comparison between extraperitoneal and transperitoneal approach in Japanese patients

et al. 2017

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BackgroundRobot-assisted radical prostatectomy (RARP) is commonly performed using the transperitoneal (TP) approach with six trocars over an 8-cm distance in the steep Trendelenburg position. In this study, we investigated the feasibility and the benefit of using the extraperitoneal (EP) approach with six trocars over a 4-cm distance in a flat or 5° Trendelenburg position. We also introduced four new steps to the surgical procedure and compared the surgical results and complications between the EP and TP approach using propensity score matching.MethodsBetween August 2012 and August 2016, 200 consecutive patients without any physical restrictions underwent RARP with the EP approach in a less than 5° Trendelenburg position, and 428 consecutive patients underwent RARP with the TP approach in a steep Trendelenburg position. Four new steps to RARP using the EP approach were developed: 1) arranging six trocars; 2) creating the EP space using laparoscopic forceps; 3) holding the separated prostate in the EP space outside the robotic view; and 4) preventing a postoperative inguinal hernia. Clinicopathological results and complications were compared between the EP and TP approaches using propensity score matching. Propensity scores were calculated for each patient using multivariate logistic regression based on the preoperative covariates.ResultsAll 200 patients safely underwent RARP using the EP approach. The mean volume of estimated blood loss and duration of indwelling urethral catheter use were significantly lower with the EP approach than the TP approach (139.9 vs 184.9 mL, p = 0.03 and 5.6 vs 7.7 days, p < 0.01, respectively). No significant differences in the positive surgical margin were observed. None of the patients developed an inguinal hernia postoperatively after we introduced this technique.ConclusionsThe EP approach to RARP was safely performed regardless of patient physique or contraindications to a steep Trendelenburg position. Our method, which involved using the EP approach to perform RARP, can decrease the amount of perioperative blood loss, the duration of indwelling urethral catheter use, and the incidence of postoperative inguinal hernia development.

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“…In the setting of an CUAJ -CUA Guideline Rourke et al Guideline: Urethral stricture 11 © 2020 Canadian Urological Association asymptomatic VUAS, observation is appropriate as in some patients' the treatment of a VUAS results in de novo or worsening of urinary incontinence. 110 Paradoxically, in some patients, treatment of the VUAS can actually improve post-prostatectomy incontinence by passively improving the coaptation of the external urethral sphincter. 110 Patients who are symptomatic, or those who have a VUAS <14 French and are contemplating post-prostatectomy incontinence surgery should be treated initially with a urethral dilation or minimally invasive endoscopic procedures; often multiple procedures are necessary, but in most cases this is eventually successful.…”

Section: Vesicourethral Anastomotic Stenosis (Vuas)mentioning

confidence: 99%

“…110 Paradoxically, in some patients, treatment of the VUAS can actually improve post-prostatectomy incontinence by passively improving the coaptation of the external urethral sphincter. 110 Patients who are symptomatic, or those who have a VUAS <14 French and are contemplating post-prostatectomy incontinence surgery should be treated initially with a urethral dilation or minimally invasive endoscopic procedures; often multiple procedures are necessary, but in most cases this is eventually successful. 111 Usually a stepwise approach of a minimally traumatic urethral dilation, followed by a cold knife/electrocautery or laser incision of the stricture, and finally a deep incision or resection to the fat can be attempted, with success rates increasing with move invasive treatment methods.…”

Section: Vesicourethral Anastomotic Stenosis (Vuas)mentioning

confidence: 99%

Canadian Urological Association guideline on male urethral stricture

Rourke¹,

Welk²,

Kodama³

et al. 2020

CUAJ

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Urethral stricture is fundamentally a fibrosis of the urethral epithelial and associated corpus spongiosum which in turn causes obstruction of the urethral lumen. Patients with urethral stricture most commonly present with lower urinary tract symptoms, urinary retention or urinary tract infection but may also experience a broad spectrum of other signs and symptoms including genitourinary pain, hematuria, abscess, ejaculatory dysfunction, or renal failure. When urethral stricture is initially suspected based on clinical assessment, cystoscopy is suggested as the modality that most accurately establishes the diagnosis. This recommendation is based on several factors including the accuracy of cystoscopy as well as its wide availability, lesser overall cost, and comfort of urologists with this technique. When recurrent urethral stricture is suspected, we suggest performing retrograde urethrography to further stage the length and location of the stricture or referring the patient to a physician with expertise in reconstructive urology. Ultimately, the treatment decision depends on several factors, including the type and acuity of patient symptoms, the presence of complications, prior interventions, and the overall impact of the urethral stricture on the patient’s quality of life. Endoscopic treatment either as dilation or internal urethrotomy is suggested rather than urethroplasty for the initial treatment of urethral stricture. This recommendation applies to men with undifferentiated urethral stricture and does not apply to trauma-related urethral injuries, penile urethral strictures (hypospadias, lichen sclerosus) or suspected urethral malignancy. In the setting of recurrent urethral stricture, urethroplasty is suggested rather than repeat endoscopic management but this may vary depending on patient preference and impact of the symptoms on the patient.

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Postprostatectomy Anastomosis Stenosis: A Systematic Review

Cited by 13 publications

References 42 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

New steps of robot-assisted radical prostatectomy using the extraperitoneal approach: a propensity-score matched comparison between extraperitoneal and transperitoneal approach in Japanese patients

Canadian Urological Association guideline on male urethral stricture

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