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Anastomosenstenose nach radikaler Prostatektomie und Blasenhalsenge nach operativer Therapie der benignen Prostatahyperplasie: rekonstruktive Möglichkeiten

Anastomosis stenosis after radical prostatectomy and bladder neck stenosis after benign prostate hyperplasia treatment: reconstructive options

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Zusammenfassung

Blasenhalsengen (BHE) nach operativer Therapie der benignen Prostatahyperplasie (BPH) und Anastomosenstenosen (AS) nach radikaler Prostatektomie beim Prostatakarzinom treten regelmäßig auf. Beide Krankheitsbilder sollten jedoch wegen der zugrunde liegenden Pathologie, der Anatomie und der operativen Ergebnisse getrennt betrachtet werden. AS treten mit einer Inzidenz von 0,2–28 % meist innerhalb der ersten 2 Jahre postoperativ auf. Die initiale Therapie sollte endourologisch per Dilatation, (Laser)schlitzung oder Resektion erfolgen. Nach drei erfolglosen Versuchen sollte eine offene Rekonstruktion erfolgen. Hierfür sind verschiedene Zugangswege (abdominell, perineal, abdominoperineal) beschrieben, die alle mit guten Erfolgsraten einhergehen. Allerdings besteht ein hohes Inkontinenzrisiko. Die Inkontinenz kann erfolgreich mit der Implantation eines artifiziellen Sphinkters therapiert werden. Die Inzidenz der BHE liegt über alle desobstruierenden Verfahren hinweg bei ca. 5 %. In der Regel treten BHE in den ersten 2 Jahren auf. Auch hier sollte zunächst eine endourologische Therapie erfolgen. Bei rezidivierenden BHE ist eine offene Rekonstruktion zu empfehlen. Die YV-Plastik ist dabei eine etablierte Operation, die T‑Plastik stellt eine Modifikation dar. Die Erfolgsrate der offenen Rekonstruktion ist hoch. Sowohl für die AS als auch für die BHE liegen erste Fallbeschreibungen für robotisch assistierte Rekonstruktionen vor.

Abstract

Bladder neck stenosis (BNS) after simple prostatectomy and vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy for prostate cancer are common sequelae. However, the two entities differ in their pathology, anatomy and their surgical results. VUAS has an incidence of 0.2–28%. Commonly, VUAS occurs within the first 2 years after surgery. Initial therapy should be performed endourologically: dilatation, (laser) incision or resection. After three unsuccessful treatment attempts, open reconstruction should be considered. Different surgical approaches (abdominal, perineal, abdominoperineal) have been described. All are associated with good success rates. However, they are accompanied by high rates of urinary incontinence. Incontinence can be treated safely by implantation of an artificial urinary sphincter. The incidence of BNS is around 5% for all types of surgery for benign prostate hyperplasia. It occurs within the first 2 years after surgery. Initial treatment should be performed endourologically. In case of recalcitrant BNS, open reconstruction is indicated. The YV-plasty is an established procedure, and the T‑plasty represents a modification. Success rates of both procedures are high. Robot-assisted reconstructive procedures have been described for both VUAS and BNS.

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  1. Klinik für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland

    C. M. Rosenbaum, B. Becker, A. Gross & C. Netsch

  2. Young academic urologists – working group trauma and reconstructive urology, EAU, Arnheim, Niederlande

    C. M. Rosenbaum

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  1. C. M. Rosenbaum
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Correspondence to C. M. Rosenbaum.

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C.M. Rosenbaum, B. Becker, A. Gross und C. Netsch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rosenbaum, C.M., Becker, B., Gross, A. et al. Anastomosenstenose nach radikaler Prostatektomie und Blasenhalsenge nach operativer Therapie der benignen Prostatahyperplasie: rekonstruktive Möglichkeiten. Urologe 59, 398–407 (2020). https://doi.org/10.1007/s00120-020-01143-7

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