Original Papers - Prostate
Vol. 96 No. 4 (2024)
Outcomes of transperineal reanastomosis as a salvage treatment for recurrent vesicourethral anastomosis stenosis after radical prostatectomy
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 18 July 2024
Accepted: 26 August 2024
Accepted: 26 August 2024
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Purpose: To evaluate transperineal reanastomosis (TRPA) combined with incontinence surgery as a complex treatment for recurring vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy (RP).
Methods: Retrospective analysis of 8 patients who underwent TRPA for recurring VUAS. Detailed preoperative and follow up data were assessed.
Results: Mean follow up lasted 47 months (range 17-77) with mean age being 63.4 years (range 61-70). All patients achieved patency and 87.5% (7/8) maintained it to the end of follow up. However, four of them required additional procedures to retain patency. Six underwent incontinence surgery – artificial urinary sphincter (AUS) implantation – after which one cuff erosion occurred. In the end 62.5% (5/8) of patients achieved patent urethra and continence.
Conclusions: TRPA combined with incontinence surgery is a reasonable treatment for patients with recurrent VUAS. Nonetheless, this is a set of difficult surgeries that may ultimately end in failure, i.e. the inability to restore urethral patency, urinary incontinence or urinary diversion, hence they should be performed by experienced surgeons.
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Citations
Bergengren O, Pekala KR, Matsoukas K, et al. 2022 Update on Prostate Cancer Epidemiology and Risk Factors-A Systematic Review. Eur Urol. 2023; 84:191-206.
Rosenbaum CM, Fisch M, Vetterlein MW. Contemporary Management of Vesico-Urethral Anastomotic Stenosis After Radical Prostatectomy. Front Surg. 2020; 7:587271.
Delchet O, Nourredine M, González Serrano A, et al. Post-prostatectomy anastomotic stenosis: systematic review and meta-analysis of endoscopic treatment. BJU Int. 2024; 133:237-45.
Mundy AR, Andrich DE. Posterior urethral complications of the treatment of prostate cancer. BJU Int. 2012;110:304-25.
Breyer BN, Davis CB, Cowan JE, et al. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. 2010; 106:1734-8.
Hu JC, Gold KF, Pashos CL, et al. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol Off J Am Soc Clin Oncol. 2003; 21:401-5.
Carlsson S, Nilsson AE, Schumacher MC, et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010; 75:1092-7.
Parihar JS, Ha YS, Kim IY. Bladder neck contracture-incidence and management following contemporary robot assisted radical prostatectomy technique. Prostate Int. 2014; 2:12-8.
Britton CJ, Sharma V, Fadel AE, et al. Vesicourethral Anastomotic Stenosis Following Radical Prostatectomy: Risk Factors, Natural History, and Treatment Outcomes. J Urol. 2023; 210:312-22.
Pfalzgraf D, Beuke M, Isbarn H, et al. Open retropubic reanastomosis for highly recurrent and complex bladder neck stenosis. J Urol. 2011; 186:1944-7.
LaBossiere JR, Cheung D, Rourke K. Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success. J Urol. 2016; 195:1495-500.
Reiss CP, Pfalzgraf D, Kluth LA, et al. Transperineal reanastomosis for the treatment for highly recurrent anastomotic strictures as a last option before urinary diversion. World J Urol. 2014; 32:1185-90.
Theodoros C, Katsifotis C, Stournaras P, et al. Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures. Eur Urol. 2000; 38:734-740.
Flynn BJ, Webster GD. Evaluation and surgical management of intrinsic sphincter deficiency after radical prostatectomy. Rev Urol. 2004; 6:180-6.
Ullate A, Arance I, Virseda-Chamorro M, et al. ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture. J Clin Med. 2022;11:4882.
Van der Aa F, Drake MJ, Kasyan GR, et al. . The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol. 2013; 63:681-9.
Białek Ł, Frankiewicz M, Adamowicz J, et al. Urethral management after artificial urinary sphincter explantation due to cuff erosion. Cent Eur J Urol. 2023; 76:322-4.
Lentz AC, Peterson AC, Webster GD. Outcomes following artificial sphincter implantation after prior unsuccessful male sling. J Urol. 2012; 187:2149-53.
Fisher MB, Aggarwal N, Vuruskan H, Singla AK. Efficacy of artificial urinary sphincter implantation after failed bone-anchored male sling for postprostatectomy incontinence. Urology. 2007; 70:942-4.
Lai HH, Boone TB. Complex artificial urinary sphincter revision and reimplantation cases--how do they fare compared to virgin cases? J Urol. 2012; 187:951-5.
McGeady JB, McAninch JW, Truesdale MD, et al. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol. 2014;192:1756-61.
Schuettfort VM, 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. 2017; 35:1885-90.
Nikolavsky D, Blakely SA, Hadley DA, et al. Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy. Int Urol Nephrol. 2014; 46:2147-52.
Shahrour W, Hodhod A, Kotb A, et al. Dorsal Buccal Mucosal Graft Urethroplasty for Vesico-Urethral Anastomotic Stricture Postradical Prostatectomy. Urology. 2019; 130:210.
Doležel J, Hrabec R, Uher M, et al. Substitution Urethroplasty With Buccal Mucosal Graft in the Management of Stricture of Vesicourethral Anastomosis or Membranous Urethra: Single-institution Long-term Experience With Perineal Approach and Endourethroplasty. Urology. 2024; S0090-4295(24)00418-7.
How to Cite
Outcomes of transperineal reanastomosis as a salvage treatment for recurrent vesicourethral anastomosis stenosis after radical prostatectomy. (2024). Archivio Italiano Di Urologia E Andrologia, 96(4). https://doi.org/10.4081/aiua.2024.12829
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