THE OWN EXPERIENCE IN THE TREATMENT
OF STRICTURES OF VESICOURETHRAL ANASTOMOSIS
AFTER RADICAL PROSTATECTOMIES
Article published in Urologia Polska 1997/50/3.
authors
-
Romuald Zdrojowy
- Katedra i Klinika Urologii AM we Wroc³awiu
Kierownik Kliniki: prof. dr hab. med. Jerzy Lorenz
keywords
-
prostate cancer radical prostatectomy vesicourethral anastomosis stricture
summary
- Objective. The stricture of vesicourethral anastomosis is the strenuous
- complication after radical retropubic prostatectomy. In urologic Publications
- the fre±uency of this complication is estimated as high as 20 percent. In the
- treatment the catheter dilatation, electroresection and electrocoagulation, visual
- urethrotomy, baloon dilatation and laser vaporisation is advocated. Its
- prevention during surgical procedure is also consider to be as the important
- factor. The factors increasing their appearance risk are: the prolonged urine
- leakage through vesicourethral anastomosis, huge intraoperative haemorrhage
- and previous endoscopic prostate procedures. The efficacy of cold-knife visual
- incision of the vesicourethral anastomotic stricture was evaluated.
- Patients and methods. Between 1990-1996 in the Wroc³aw Clinic of Urology
- the 96 radical retropubic prostatectomies were performed. In 6/96 patients the
- stricture of vesicouerthral junction was diagnosed. One patient had the local
- prostate cancer progression and therefore he was excluded from the observation
- group. In the rest 5/96 patients (5,2%) PSA, DRE and TRUS showed no local
- progression. The diagnosis was assign by means of anamnesis, uroflowmetry
- and urethroscopy. The postoperative scar was the cause of the anastomotic
- stricture. In 2/5 patients (40%) the stricture was presented sooner than 8 weeks,
- in 1 patient even 5 years after radical prostatectomy. All patients had optical
- cold-knife urethrotomy at 12 o'clock and were catheterised 24 hours. The
- observation period lasts for 5 months to 4 years.
- Results. Four men (80%) were treated successfully with one endoscopic
- incision; also the patient with "mature" anastomotic stricture had one procedure.
- In one man recurrent anastomotic stricture after 2 months appeared and
- subse±uent optical urethrotomy had to be performed. There was no more
- recurrence in this case during the observation period. The urethrotomy had no
- negative influence on urine continence. All procedures were performed
- ambulatory.
- Conclusion. The optical urethrotomy is the efficacious and safe procedure
- in the treatment of the vesicourethral anastomotic stricture after radical
- prostatectomy.
references
- [1] Bodker, A., Ostri, R, Rye-Anderson, }., Edvardsen, L., Struckmann, J.:
- Treatment of recurrent urethral stricture by internal urethrotomy and intermittent
- self-catheterisation: a controlled study of a new therapy. J. Urol., 1992,148, 308.
- [2] Carr, L. K., Webster, G. D.: Endoscopic management of the obliterated anasto-
- mosis following radical prostatectomy. J. Urol., 1996, 156, 70-72.
- [3] Chiou, R. K., Gonzales, R., Ortlip, S., Fraley, E. E.: Endoscopic treatment
- of posterior urethral obliteration: long-term follow-up and Comparison with trans-
- pubic Urethroplasty. J. Urol., 1988,140, 508.
- [4] Chuang, C. K., Lai, M. K., Chu, S. H.: Optic internal urethrotomy under
- transrectal ultrasonographic guide and suprapubic fiberoscopic aid. J. Urol., 1994,
- 152, 1435.
- [5] Dalkin, B. L.: Endoscopic evaluation and treatment of anastomotic strictures
- after radical retropubic prostatectomy. J. Urol., 1996, 155, 206-208.
- [6] Igel, T. C, Barrett, B. M., Segura, J. W., Benson, R. C, Rife, C. C:
- Perioperative and postoperative complications from bilateral pehic lymphadenec-
- tomy and radical retropubic prostatectomy. J. Urol., 1987,137,1189.
- [7] Keetch, D. W., Andriole, G. L., Catalona, W. J.: Complications of radical
- retropubic prostatectomy. AUA Update Series, 1994,13, 6.
- [8] Kohrmann, K. U., Henkel, T. O., Schmidt, R, Rassweiler, J.: Antegrade-
- retrograde urethrotomy for treatment of severe strictures of the urethra: experience
- and literature reniew. J. Endourol., 1994, 8, 433.
- [9] Kulp, D., Gomella, L.: Transurethral contact laser incision (CLI) of bladder
- neck contractures. J. Urol., 1993, 149, part 2, 498A, 1141.
- [10] Lange, P. H., Reddy, P. K.: Technical nuances and surgical results of radical
- retropubic prostatectomy in 150 patients. J. Urol., 1987, 138, 348.
- [11] Leandri, P., Rossignol, G., Gautier, J. R., Ramon, J.: Radical retropubic
- prostatectomy morbidity and auality of life. Experience with 620 consecutive ca-
- ses. J. Urol., 1992, 147, part 2, 883.
- [12] Lieberman, S. R, Barry, J. M.: Retreat from transpubic Urethroplasty for oblit-
- erated membranous urethral strictures. J. Urol., 1988, 140, 508.
- [13] Mark, S., Perez, L. M., Webster, G. D.: Synchronous management of anasto-
- motic contracture and stress urinary incontinence following radical prostatecto-
- my. J. Urol., 1994,151,1202.
- [14] Newman, L. H., Stone, M. M., Chircus, J. H., Kramer, H. C.: Recurrent
- urethral stricture disease managed by clean intermittent self-catheterization. J.
- Urol., 1990, 144, 1142.
- [15] Ramchandani, R, Banner, M. R, Berlin, J. W., Dannenbaum, M. S.,
- Wein, A. J.: Vesicourethral anastomotic strictures after radical prostatectomy:
- efficacy of transurethral baloon dilatation. Radiology, 1994, 193, 345.
- [16] Schellhammer, R, Jordan, G., Schlossberg, S.: Transurethral baloon dilata-
- tion of anastomotic stricture after radical prostatectomy. Conterporary Urol.,
- 1994, 16.
- [17] Schlossberg, S., Jordan, G., Schellhammer, R: Repair of obliterative vesi-
- courethral stricture after radical prostatectomy: a techni±ue for presewation of
- continence. Urology, 1995, 45, 510.
- [18] Surya, B. V., Provet,)., Johanson, K. E., Brown, J.: Anastomotic strictures
- following radical prostatectomy: risk factors and management. J. Urol., 1990,143,
- 755.
- [19] Veenema, R. ]., Gursel, E. O., Lattimer, J. K.: Radical retropubic prostatec-
- tomy for cancer: a 20-years experience. J. Urol., 1977, 117, 330.
- [20] Walsh, R C., Retik, A. B., Stamey, T. A., Vaughan, E. D.: CampbelYs
- Urology. W. B. Saunders Co., Philadelphia, 1992, 2865-2886.
- [21] Webster, G. D., Sihelnik, S.; The management of strictures of the membranous
- urethra. ]. Urol., 1985, 134, 469.
|