W Tomschi1, G Suster, W Höltl. 1. Department of Urology, Kaiser Franz Joseph Spital, Vienna, Austria.
Abstract
OBJECTIVE: To investigate the factors responsible for anastomotic strictures of the bladder neck after radical retropubic prostatectomy. PATIENTS AND METHODS: Of 239 consecutive patients who underwent radical retropubic prostatectomy between 1987 and 1996, 36 (15%) developed anastomotic strictures after surgery. The influence of tumour stage, previous prostatic surgery, urinary extravasation and postoperative bacteriuria were assessed. RESULTS: In 21 patients (58%), the bladder neck stricture occurred within 3 months of surgery, in 11 (30%) at 4-12 months after surgery and in four (11%) more than 12 months after surgery; three of these also had local recurrence. Advanced tumour stage and positive margins did not correlate with a higher stricture rate, nor was there a significant difference in stricture rates with three or four anastomotic sutures. However, extravasation at the time of catheter removal (16 of 36 patients (44%) with vs 34 of 183 patients without (19%) stricture, bacteriuria of > 10(6) c.f.u./mL at the time of catheter removal (stricture group 21 of 36 patients (58%) stricture with vs 71 of 203 (35%) without) and previous prostatic surgery (TURP or open surgery, stricture in 28% of those previously operated vs 13% with no previous surgery) were significant risk factors. CONCLUSION: There are three risk factors for anastomotic stricture after radical prostatectomy: previous operations on the prostate, extravasation and asymptomatic bacteriuria.
OBJECTIVE: To investigate the factors responsible for anastomotic strictures of the bladder neck after radical retropubic prostatectomy. PATIENTS AND METHODS: Of 239 consecutive patients who underwent radical retropubic prostatectomy between 1987 and 1996, 36 (15%) developed anastomotic strictures after surgery. The influence of tumour stage, previous prostatic surgery, urinary extravasation and postoperative bacteriuria were assessed. RESULTS: In 21 patients (58%), the bladder neck stricture occurred within 3 months of surgery, in 11 (30%) at 4-12 months after surgery and in four (11%) more than 12 months after surgery; three of these also had local recurrence. Advanced tumour stage and positive margins did not correlate with a higher stricture rate, nor was there a significant difference in stricture rates with three or four anastomotic sutures. However, extravasation at the time of catheter removal (16 of 36 patients (44%) with vs 34 of 183 patients without (19%) stricture, bacteriuria of > 10(6) c.f.u./mL at the time of catheter removal (stricture group 21 of 36 patients (58%) stricture with vs 71 of 203 (35%) without) and previous prostatic surgery (TURP or open surgery, stricture in 28% of those previously operated vs 13% with no previous surgery) were significant risk factors. CONCLUSION: There are three risk factors for anastomotic stricture after radical prostatectomy: previous operations on the prostate, extravasation and asymptomatic bacteriuria.
Authors: Christoph Philip Reiss; Daniel Pfalzgraf; Luis Alex Kluth; Armin Soave; Margit Fisch; Roland Dahlem Journal: World J Urol Date: 2013-10-29 Impact factor: 4.226