Vesicourethral Anastomotic Strictures after Radical Retropubic Prostatectomy: The Experience of a Single Institution

Abstract

Objective: Stricture of the vesicourethral anastomosis remains a well-documented complication after radical retropubic prostatectomy. Materials and Methods: We performed a retrospective study of 294 patients with prostate cancer who underwent radical retropubic prostatectomy. Possible correlations between anastomotic stricture formation, tumor stage, positive surgical margins, number of anastomotic sutures, bladder neck preservation, urine leakage, previous prostate surgery and/or intraoperative blood loss were examined. Results: An anastomotic stricture was found in 18 cases (6%) requiring some kind of treatment. In 10 patients (56%), the bladder neck stricture occurred within 3 months after surgery, in 5 (28%) at 4–12 months after surgery and in 3 (16%) more than 12 months after surgery. Intraoperative blood loss (>1,000 ml) was found to be significantly correlated with urinary leakage (p < 0.001) and both correlated with anastomotic stricture formation (p < 0.005). Conclusion: Excessive intraoperative blood loss (>1,000 ml) and urine leakage was found to be significantly correlated to the formation of anastomotic stricture following radical retropubic prostatectomy.

Assessing the vesico‐urethral anastomosis after radical retropubic prostatectomy: transrectal ultrasonography can replace cystography

“…Because of moderate or marked VE (Figs 4 and 5) we repeated TRUS and cystography in eight patients after 7 days; in three and five the catheter could be removed 14 and 21 days after RRP, respectively. The mean (range) radiation dose was 46.4 (9-151) cGy/cm 2 . The clinical and histopathological data showed no statistically significant differences between patients with and with no VE (Table 1).…”

“…Premature catheter removal in presence of anastomotic leakage can induce fibrosis and subsequent vesico-urethral stricture [1,2]. Fig.…”

“…Leakage of the vesico-urethral anastomosis after radical retropubic prostatectomy (RRP) can be associated with higher rates of strictures in cases of premature catheter removal [1,2]. Cystography provides a reliable assessment of the anastomotic region, but requires the use of X-rays and contrast medium.…”

Transrectal Contrast-Enhanced Ultrasonography, Transrectal Ultrasonography and Retrograde Cystography for the Detection of Vesicourethral Anastomosis Leakage after Radical Retropubic Prostatectomy: A Prospective Comparative Evaluation

“…In case of early catheter removal, assessment of the VUA is strongly recommended to minimize complications [3,4,5]. A premature catheter removal in the presence of significant extravasation could lead to an increased production of fibrotic tissue and thus may increase the risk of developing strictures later on [6,7,8]. …”

Risk factors and correction methods for postoperative vesicourethral anastomotic strictures: literature review

“…Так, в работе A. Kostakopoulos и соавт. выяв-лена явная связь между интраоперационной кровопотерей >1000 мл и наличием затеков мочи в послеоперационном периоде (p <0,001), а также корреляция обоих этих факторов с развитием после-операционного СВУА (p <0,005) [17,31]. При этом в обзоре литературе, проведенном A. El-Hakim и со-авт., приводится однозначное заключение, что объем интраоперационной кровопотери не влияет на риск формирования СВУА [32].…”