Reconstructive UrologyRisk Factors and Quality of Life for Post-prostatectomy Vesicourethral Anastomotic Stenoses
Section snippets
Patient Selection, Operative Technique, and Postoperative Surveillance
Through our Institutional Review Board (IRB)–approved prostate cancer database, we identified 1038 patients undergoing RARP and 707 patients undergoing open RRP for clinically localized prostate cancer, from September 2001 to December 2009. This period represented a common time frame during which both open and robotic radical prostatectomies were performed at our institution. In addition, we excluded patients who received preoperative radiation therapy and censored patients for the development
Results
Demographic characteristics of both patients undergoing open RRP and RARP are detailed in Table 1. There were several statistically significant differences. Patients undergoing RARP tended to be slightly older (mean 60.4 vs 59.7 years, P = .04), have more medical comorbidities, including diabetes mellitus (9.6 vs 6.5%, P = .02), hypertension (25.9 vs 5.5%, P < .0001), and congestive heart failure (8 vs 4.1%, P = .02). They had fewer high-grade (8+) biopsy Gleason scores (5.2 vs 10.5%, P =
Comment
VUAS incidence is significantly lower after robot-assisted vs open prostatectomy techniques (7.5 vs 2.1% P < .0001). Independent predictors of VUAS include open surgery, PSA recurrence, and postoperative hematuria, urinary leak and urinary retention. PSA recurrence as an independent predictor may indicate unrecognized advanced tumor stage with micrometastatic disease, rendering surgery more difficult. Robot assistance is thought to provide enhanced pelvic visualization9 and improved
Conclusions
Overall, the incidence of VUAS is significantly decreased in robot-assisted vs open radical prostatectomies. This may be attributed to a variety of factors, including downward stage migration of prostate cancer over time and the advantages of robotics (improved visualization, a running anastomosis). Surgical expertise is paramount, with precise dissection and creation of a water-tight anastomosis. Here, we attempt to identify significant independent predictors of VUAS development: open
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