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Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up

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Abstract

Objectives

To re-evaluate safety and efficacy of transperineal reanastomosis (TPRA) as a viable therapeutic option in highly recurrent anastomotic strictures (AS) after radical retropubic prostatectomy (RRP).

Methods

Retrospective analysis by standardized questionnaire inquiring for recurrence of stricture, stress urinary incontinence (SUI), sexual function, satisfaction, and changes in quality of life (QoL) was performed in all patients undergoing TPRA. Validated questionnaires (ICIQ-UI, EQ-5D, and IPSS) were included.

Results

Median follow-up was 45.0 months. The average number of prior operations was 4.69. Success rate was 87% (20/23). Three recurrences were successfully treated via endoscopic means. All patients had urinary incontinence pre-op and post-op. Implantation of an artificial urinary sphincter (AUS) has been performed successfully in 73.9% (17/23). Rate of complications was low (8.7%; 2/23, Clavien–Dindo Grade II + III). EQ-5D-VAS showed a good general state of health (73.5/100). An improvement in QoL was noted in 63.6% (14/22) and patient satisfaction was high (72.7%; 16/22).

Conclusions

This extended follow-up confirms the initial results for TPRA as an excellent treatment option for highly recurrent AS after RRP. Postoperative SUI as a consequence of transsphincteric urethral mobilization can be satisfactorily treated by the implantation of AUS. In case of AS recalcitrant to endoscopic treatment, the described procedure—even though technically challenging—represents a valuable treatment option.

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Abbreviations

AS :

Anastomotic stricture

RRP :

Retropubic prostatectomy

TPRA :

Transperineal reanastomosis

SUI :

Stress urinary incontinence

AUS :

Artificial urinary sphincter

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Author notes

  1. Victor Maximilian Schuettfort and Roland Dahlem have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Victor Maximilian Schuettfort, Roland Dahlem, Luis Kluth, Clemens Rosenbaum, Tim Ludwig, Margit Fisch & Christoph-Philip Reiss

  2. Department of Urology, University Medical Centre Mannheim, Mannheim, Germany

    Daniel Pfalzgraf

Authors
  1. Victor Maximilian Schuettfort
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  2. Roland Dahlem
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Contributions

VMS: project development, data collection, data analysis, manuscript writing, and data analysis. RD: project development, data analysis, and manuscript writing. LK, DP, CR, TL, and MF: manuscript writing + editing, CPR: project development, data collection, and manuscript writing.

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Correspondence to Victor Maximilian Schuettfort.

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The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required (retrospective study).

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Schuettfort, V.M., Dahlem, R., Kluth, L. et al. Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up. World J Urol 35, 1885–1890 (2017). https://doi.org/10.1007/s00345-017-2067-8

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  • DOI: https://doi.org/10.1007/s00345-017-2067-8

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