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Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy

  • Urology - Original Paper
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Abstract

Objectives

To determine the outcomes of open vesicourethral anastomotic reconstruction (VUAR) for outlet stenosis following radical prostatectomy (RP).

Methods

Review of all cases of VUAR within an IRB-approved database was performed. Preoperative factors assessed included cancer treatment modality, duration of symptoms, prior treatments, and length of defect. Outcomes reviewed included length-of-stay (LOS), complications, maintenance of patency, continence, and need for additional procedures.

Results

Twelve cases of VUAR performed by a single surgeon (BJF) from 2004 to 2012 were identified. Surgical approaches were either abdominal (7), perineal (3), or abdominoperineal (2). All patients underwent prior RP, with 25 % having subsequent radiotherapy. Among patients with stenosis, 43 % were completely obliterated. Two cases had prior anastomotic disruption in the early postoperative period after RP. The median length of stenosis was 2.5 cm (range 1–5 cm) and median LOS was 3.0 days (range 1–7 days). At a median follow-up of 75.5 months (range 14–120 months), 92 % of men retained patency; only 25 % were continent.

Conclusion

In experienced hands, VUAR can restore durable patency for men afflicted with outlet stenosis after RP. Despite anatomic restoration, incontinence is likely.

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Authors and Affiliations

  1. Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA

    Dmitriy Nikolavsky

  2. Division of Urology, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Academic Office One Bldg, 12631 East 17th Ave., Box C319, Room L15-5602, Aurora, CO, 80045, USA

    Stephen A. Blakely, Paul Knoll, Andrew P. Windsperger & Brian J. Flynn

  3. Division of Urology, Loma Linda University, Loma Linda, CA, USA

    David A. Hadley

  4. Department of Urology, Wake Forest University, Winston-Salem, NC, USA

    Ryan P. Terlecki

Authors
  1. Dmitriy Nikolavsky
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  2. Stephen A. Blakely
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  3. David A. Hadley
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  4. Paul Knoll
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  6. Ryan P. Terlecki
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  7. Brian J. Flynn
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Correspondence to Brian J. Flynn.

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Nikolavsky, D., Blakely, S.A., Hadley, D.A. et al. Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy. Int Urol Nephrol 46, 2147–2152 (2014). https://doi.org/10.1007/s11255-014-0816-9

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  • DOI: https://doi.org/10.1007/s11255-014-0816-9

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