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Abbosov S, Sorokin N, Shomarufov A, Kadrev A, Nuriddinov KU, Mukhtarov S, Akilov F, Kamalov A. Bladder neck contracture as a complication of prostate surgery: Alternative treatment methods and prospects (literature review). UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_127_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meyer CP, Lamp J, Vetterlein MW, Soave A, Engel O, Dahlem R, Fisch M, Kluth LA. Impact of Cardiovascular and Metabolic Risk Factors on Stricture Recurrence After Anterior One-stage Buccal Mucosal Graft Urethroplasty. Urology 2020; 146:253-259. [PMID: 32950595 DOI: 10.1016/j.urology.2020.07.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the impact of cardiovascular, metabolic and smoking related risk factors on recurrence in patients with buccal mucosal graft urethroplasty for anterior urethral strictures. PATIENTS AND METHODS Retrospective single-center analysis between 2009 and 2016. Covariates included American Society of Anesthesiology (ASA) score, body mass index, and smoking status (never vs ever), coronary artery disease, arterial hypertension, diabetes mellitus, change in hemoglobin, creatinine, c-reactive protein, and leucocyte count. Descriptive and survival analyses evaluated the association with stricture recurrence. RESULTS Overall, 1039 patients had buccal mucosal graft urethroplasty of which 517 remained for final analysis. Patients with stricture recurrence (n = 76) were significantly older (P < .001), had a higher American Society of Anesthesiology score (P = .006), higher proportion coronary artery disease (P = .011), and hypertension (P = .003) compared to those patients without stricture recurrence. Patients without stricture recurrence had a significantly larger drop in hemoglobin (1.5 [0.9, 2.1] vs 1.2 [0.7, 1.8]) mg/dl ( = .005).Overall stricture-free recurrence rate was 86%, with a median follow-up of 32 (95% confidence interval: 26-30) months. In multivariable analysis, a larger drop of hemoglobin remained the only independent, statistically significant negative predictor of stricture recurrence (Hazard ratio, 95% confidence interval: 0.74, 0.57-0.97, P = .03). CONCLUSION A larger drop of hemoglobin is independently associated with recurrence free survival. This may be considered as a surrogate marker for good microvascular circulation of the corpus spongiosum and therefore neovascularization of the graft. Contrary to the existing and mostly heterogenous previous studies, our findings suggest that stricture recurrence is largely independent of cardiovascular and metabolic risk factors.
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Affiliation(s)
- Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jule Lamp
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luis A Kluth
- Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany
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Giúdice CR, Lodi PE, Olivares AM, Tobia IP, Favre GA. Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy. Int Braz J Urol 2019; 45:253-261. [PMID: 30325608 PMCID: PMC6541121 DOI: 10.1590/s1677-5538.ibju.2017.0681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/17/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 – 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 – 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. Conclusion: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.
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Affiliation(s)
- Carlos Roberto Giúdice
- Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina
| | - Patricio Esteban Lodi
- Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina
| | - Ana Milena Olivares
- Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Pablo Tobia
- Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina
| | - Gabriel Andrés Favre
- Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina
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Pfalzgraf D, Siegel FP, Kriegmair MC, Wagener N. Bladder Neck Contracture After Radical Prostatectomy: What Is the Reality of Care? J Endourol 2017; 31:50-56. [DOI: 10.1089/end.2016.0509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Pfalzgraf
- Department of Urology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian P. Siegel
- Department of Urology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Maximilian C. Kriegmair
- Department of Urology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina Wagener
- Department of Urology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
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Chen ML, Correa AF, Santucci RA. Urethral Strictures and Stenoses Caused by Prostate Therapy. Rev Urol 2016; 18:90-102. [PMID: 27601967 DOI: 10.3909/riu0685] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The number of patients with prostate cancer and benign prostatic hyperplasia is on the rise. As a result, the volume of prostate treatment and treatment-related complications is also increasing. Urethral strictures and stenoses are relatively common complications that require individualized management based on the length and location of the obstruction, and the patient's overall health, and goals of care. In general, less invasive options such as dilation and urethrotomy are preferred as first-line therapy, followed by more invasive substitution, flap, and anastomotic urethroplasty.
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Affiliation(s)
- Mang L Chen
- California Pacific Medical Center, Davies Campus San Francisco, CA
| | - Andres F Correa
- Department of Urology, University of Pittsburgh School of Medicine Pittsburgh, PA
| | - Richard A Santucci
- Michigan State College of Medicine, The Center for Urologic Reconstruction, Detroit Medical Center Detroit, MI
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LaBossiere JR, Cheung D, Rourke K. Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success. J Urol 2016; 195:1495-1500. [DOI: 10.1016/j.juro.2015.12.073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Joseph R. LaBossiere
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Cheung
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Giudice C, D’Alessandro F, Galarza G, Fernández D, Damia O, Favre G. Surgical approach to vesicourethral anastomotic stricture following radical prostatectomy. Actas Urol Esp 2016; 40:124-30. [PMID: 26515118 DOI: 10.1016/j.acuro.2015.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/20/2015] [Accepted: 08/30/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Vesicourethral anastomotic stricture following prostatectomy is uncommon but represents a challenge for reconstructive surgery and has a significant impact on quality of life. The aim of this study was to relate our experience in managing vesicourethral anastomotic strictures and present the treatment algorithm used in our institution. PATIENTS AND METHODS We performed a descriptive, retrospective study in which we assessed the medical records of 45 patients with a diagnosis of vesicourethral anastomotic stricture following radical prostatectomy. The patients were treated in the same healthcare centre between January 2002 and March 2015. Six patients were excluded for meeting the exclusion criteria. The stricture was assessed using cystoscopy and urethrocystography. The patients with patent urethral lumens were initially treated with minimally invasive procedures. Open surgery was indicated for the presence of urethral lumen obliteration or when faced with failure of endoscopic treatment. Urinary continence following the prostatectomy was determinant in selecting the surgical approach (abdominal or perineal). RESULTS Thirty-nine patients treated for vesicourethral anastomotic stricture were recorded. The mean age was 64.4 years, and the mean follow-up was 40.3 months. Thirty-three patients were initially treated endoscopically. Seventy-five percent progressed free of restenosis following 1 to 4 procedures. Twelve patients underwent open surgery, 6 initially due to obliterative stricture and 6 after endoscopic failure. All patients progressed favourable after a mean follow-up of 29.7 months. CONCLUSIONS Endoscopic surgery is the initial treatment option for patients with vesicourethral anastomotic strictures with patent urethral lumens. Open reanastomosis is warranted when faced with recalcitrant or initially obliterative strictures and provides good results.
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Song J, Eswara J, Brandes SB. Postprostatectomy Anastomosis Stenosis: A Systematic Review. Urology 2015; 86:211-8. [PMID: 26194295 DOI: 10.1016/j.urology.2015.02.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/19/2015] [Accepted: 02/26/2015] [Indexed: 01/08/2023]
Abstract
Anastomotic strictures (AS) are uncommon but a vexing problem after radical prostatectomy. We reviewed the literature for AS treatment modalities to summarize the best management strategies for AS, as supported by current evidence. Twenty studies fit the inclusion and exclusion criteria. Weighted success rates and incontinence rates were calculated and used to create a treatment algorithm. Repeat attempts of minimally invasive methods seem to improve the success rate. Repeat procedures and more invasive techniques, however, may lead to higher incontinence rates.
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Affiliation(s)
- Joseph Song
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jairam Eswara
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Steven B Brandes
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
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Öztürk H. Treatment of recurrent vesicourethral anastomotic stricture after radical prostatectomy using plasma-button vaporization. Scand J Urol 2015; 49:371-6. [DOI: 10.3109/21681805.2015.1012115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Bladder neck contractures and the prostate cancer survivor. Curr Opin Urol 2014; 24:389-94. [PMID: 24901516 DOI: 10.1097/mou.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the cause and diagnostic and treatment concerns for bladder neck contractures (BNCs) in the prostate cancer survivor. RECENT FINDINGS BNC rates have decreased significantly in the last 2 decades, likely because of improvement in the surgical technique and increased utilization of laparoscopic and robotic surgery, which may allow better visualization of the vesicourethral anastomosis. Despite these improvements, risk factors such as smoking and coronary artery disease contribute to BNC development. Furthermore, although recent reports have questioned the classical tenets of anastomotic technique such as water-tight anastomoses, there is no evidence that these principles contribute to the risk of BNC development and should continue to be observed. The results of minimally invasive procedures such as urethral dilation and transurethral incision of the bladder neck may be improved with the use of injectable agents. SUMMARY There is little consensus regarding BNC therapy. Although several risk factors contributing to BNC development have been identified, strategies to reduce the risk are unclear. A number of therapeutic options are available, however. In the event of BNC development, treatment should be structured in a hierarchical fashion which minimizes the risk of urinary incontinence.
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Tan GY, El Douaihy Y, Te AE, Tewari AK. Scientific and technical advances in continence recovery following radical prostatectomy. Expert Rev Med Devices 2014; 6:431-53. [DOI: 10.1586/erd.09.19] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Herschorn S, Elliott S, Coburn M, Wessells H, Zinman L. SIU/ICUD Consultation on Urethral Strictures: Posterior urethral stenosis after treatment of prostate cancer. Urology 2013; 83:S59-70. [PMID: 24361008 DOI: 10.1016/j.urology.2013.08.036] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/11/2013] [Accepted: 08/16/2013] [Indexed: 10/25/2022]
Abstract
Posterior urethral stenosis can result from radical prostatectomy in approximately 5%-10% of patients (range 1.4%-29%). Similarly, 4%-9% of men after brachytherapy and 1%-13% after external beam radiotherapy will develop stenosis. The rate will be greater after combination therapy and can exceed 40% after salvage radical prostatectomy. Although postradical prostatectomy stenoses mostly develop within 2 years, postradiotherapy stenoses take longer to appear. Many result in storage and voiding symptoms and can be associated with incontinence. The evaluation consists of a workup similar to that for lower urinary tract symptoms, with additional testing to rule out recurrent or persistent prostate cancer. Treatment is usually initiated with an endoscopic approach commonly involving dilation, visual urethrotomy with or without laser treatment, and, possibly, UroLume stent placement. Open surgical urethroplasty has been reported, as well as urinary diversion for recalcitrant stenosis. A proposed algorithm illustrating a graded approach has been provided.
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Affiliation(s)
- Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Michael Coburn
- Division of Urology, Baylor College of Medicine, Houston, TX
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, Washington
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Reiss CP, Pfalzgraf D, Kluth LA, Soave A, Fisch M, Dahlem R. Transperineal reanastomosis for the treatment for highly recurrent anastomotic strictures as a last option before urinary diversion. World J Urol 2013; 32:1185-90. [DOI: 10.1007/s00345-013-1180-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/05/2013] [Indexed: 11/27/2022] Open
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Tan G, Srivastava A, Grover S, Peters D, Dorsey P, Scott A, Jhaveri J, Tilki D, Te A, Tewari A. Optimizing Vesicourethral Anastomosis Healing After Robot-Assisted Laparoscopic Radical Prostatectomy: Lessons Learned from Three Techniques in 1900 Patients. J Endourol 2010; 24:1975-83. [DOI: 10.1089/end.2009.0630] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gerald Tan
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Abhishek Srivastava
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Sonal Grover
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - David Peters
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Philip Dorsey
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Ann Scott
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Jay Jhaveri
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Derya Tilki
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Alexis Te
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Ashutosh Tewari
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
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Yi JS, Kwak C, Kim HH, Ku JH. Surgical clip-related complications after radical prostatectomy. Korean J Urol 2010; 51:683-7. [PMID: 21031087 PMCID: PMC2963780 DOI: 10.4111/kju.2010.51.10.683] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 08/26/2010] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study was to describe the surgical clip-related complications that can occur after open retropubic prostatectomy (RRP), pure laparoscopic prostatectomy (LRP), and robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods A database of 641 patients who underwent RRP (n=439), LRP (n=49), and RALP (n=153) at our institution between January 2006 and April 2009 was reviewed to identify patients with complications related to the use of surgical clips. The median follow-up time for the entire cohort was 19.0 months (range, 1-42 months). Results Of the 641 patients, 25 (5.7%), 1 (2.0%), and 2 (1.3%) had a bladder neck contracture after RRP, LRP, and RALP, respectively. Two RRP patients had a bladder stone. In total, 6 patients had surgical clip-related complications. Metal clip migration was associated with 2 (8%) of the 25 RRP cases of bladder neck contracture and both (100%) of the RRP cases of bladder stone. Moreover, both (100%) of the RALP cases of bladder neck contractures were associated with Hem-o-lok clip migration into the anastomotic site. Conclusions Surgical clips are prone to migration and may cause, or significantly contribute to, bladder neck contracture or the formation of bladder stones after radical prostatectomy. These findings also suggest that because the incidence of bladder neck contracture after RALP is low, the migration of Hem-o-lok clips should be suspected when voiding difficulty occurs after RALP.
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Affiliation(s)
- Jun Seok Yi
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Kuyumcuoglu U, Eryildirim B, Tarhan F, Faydaci G, Ozgül A, Erbay E. Antegrade endourethroplasty with free skin graft for recurrent vesicourethral anastomotic strictures after radical prostatectomy. J Endourol 2010; 24:63-7. [PMID: 19929411 DOI: 10.1089/end.2009.0076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the efficacy of the antegrade endourethroplasty technique for the management of frequently recurrent vesicourethral anastomotic strictures that develop after retropubic radical prostatectomy. PATIENTS AND METHODS Between January 2006 and February 2008, endoscopic antegrade urethroplasty was performed in 11 patients with recurrent vesicourethral anastomotic strictures that developed after retropubic radical prostatectomy (RRP). The mean age of the patients was 64.6 years. In the first step of this two-step procedure, the graft bed was prepared by transurethral resection of the vesicourethral anastomotic stricture region. In the next step, after 3 days, an Amplatz sheath was placed in the urinary bladder suprapubically. Then, an endobronchial catheter was inserted from the external urethral meatus and extended out of the body from the suprapubic region through the Amplatz sheath. A graft taken from anteromedial section of the arm was tubularized on the catheter balloon. The graft was placed into the bladder neck antegradely under endoscopic vision. Subsequently, the graft carrier catheter was fixed by previously placed two polypropylene sutures inserted into the proximal and distal part of the stricture zone percutaneously from the perineum. The transurethral catheter was taken out delicately on postoperative day 21. RESULTS Urethral patency succeeded in 6 of the 11 (54.5%) patients, and maximum flow rate was more than 13 mL/s in follow-up. Graft necrosis occurred in two patients, and the stricture recurred in three patients in two months postoperatively. CONCLUSION Antegrade endourethroplasty may be a suitable alternative to open surgical reconstruction in selected patients with recurrent bladder neck stricture following RRP. Further studies, including more patients with modifications, are needed to improve the success rate.
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Affiliation(s)
- Ugur Kuyumcuoglu
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Garg T, See WA. Bladder neck contracture after radical retropubic prostatectomy using an intussuscepted vesico-urethral anastomosis: incidence with long-term follow-up. BJU Int 2009; 104:925-8. [PMID: 19389011 DOI: 10.1111/j.1464-410x.2009.08544.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the incidence of bladder neck contracture (BNC), a known complication of radical retropubic prostatectomy (RRP), after a 9-year experience by one surgeon using a novel approach to lower urinary tract reconstruction, the intussuscepted vesico-urethral anastomosis (IVUA). PATIENTS AND METHODS After institutional review board approval, the charts of 406 patients who had RRP for clinically localized prostate cancer from March 1998 to July 2007 were reviewed retrospectively. All patients had lower urinary tract reconstruction using the IVUA technique, which involves a looped urethral suture using six double-armed sutures that are drawn 'inside-to-out' from staggered points on the urethral stump through the bladder neck opening. When the sutures are tied down, the urethra is intussuscepted into the bladder neck opening. RESULTS At a median follow-up of 48 months, three patients developed BNC: one was at increased risk secondary to a previous TURP; one had his catheter removed on the second day after RRP in the presence of a suprapubic tube and developed a BNC at his 'dry' anastomosis; and one with no risk factors developed a BNC. Balloon dilatation, laser incision and self obturation were successful in stabilizing the strictures while preserving continence. Overall, the incidence of BNC in this series was three of 406 (0.74%). CONCLUSIONS IVUA gives a lower incidence of BNC over a long-term follow-up than rates cited in previous reports. IVUA is a valuable technique for lower urinary tract reconstruction in patients undergoing RRP.
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Affiliation(s)
- Tullika Garg
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Blumenthal KB, Sutherland DE, Wagner KR, Frazier HA, Engel JD. Bladder neck contractures related to the use of Hem-o-lok clips in robot-assisted laparoscopic radical prostatectomy. Urology 2008; 72:158-61. [PMID: 18372034 DOI: 10.1016/j.urology.2007.11.105] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 11/01/2007] [Accepted: 11/19/2007] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Recently, several large series of robot-assisted laparoscopic radical prostatectomy (RALP) have described a low incidence of bladder neck contractures (BNC). We have had a similar experience at our institution. Our objective is to describe our experience with BNC after RALP and a novel relationship to the use of Hem-o-lok Clips (HOLC). METHODS We reviewed a database of patients who underwent RALP at our institution from January 2004 to September 2007 and identified patients with BNC or complications related to the use of HOLC. We performed a retrospective chart review to attempt to determine the cause of each BNC. We also performed a PubMed search and review of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. RESULTS Of 524 patients undergoing RALP, 4 had a BNC develop, 2 of the BNCs were associated with HOLC migration and erosion into the vesicourethral anastomosis, and 1 was found to have HOLC migration within the bladder. A fifth patient had an anastomotic leak develop secondary to a HOLC that migrated into the bladder neck. Two similar cases of HOLC-related migration have been reported to MAUDE. CONCLUSIONS When early BNC or unexplained urinary retention occurs after RALP, one should have a high index of suspicion for migration of HOLC. Clip use should be minimized on tissue immediately adjacent to the anastomosis, and every effort should be made to retrieve loose clips after the procedure.
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Affiliation(s)
- Kevin B Blumenthal
- Department of Urology, the George Washington University Hospital, Washington, District of Columbia 20037, USA
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Msezane LP, Reynolds WS, Gofrit ON, Shalhav AL, Zagaja GP, Zorn KC. Bladder Neck Contracture after Robot-Assisted Laparoscopic Radical Prostatectomy: Evaluation of Incidence, Risk Factors, and Impact on Urinary Function. J Endourol 2008; 22:377-83. [DOI: 10.1089/end.2006.0460] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lambda P. Msezane
- Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - W. Stuart Reynolds
- Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Ofer N. Gofrit
- Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Arieh L. Shalhav
- Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Gregory P. Zagaja
- Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Kevin C. Zorn
- Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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21
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[The revival of "uroscopy": an easy way to evaluate the anastomotic region after radical retropubic prostatectomy]. Urologe A 2008; 47:331-6. [PMID: 18210070 DOI: 10.1007/s00120-007-1615-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The cystogram after retropubic radical prostatovesiculectomy (RRP) examines the condition of the anastomosis region. There is no clear temporal recommendation for the determination of urine extravasation in cases of early removal of the catheter. This study investigates the macroscopic and microscopic examination of the bladder catheter urine after RRP. PATIENTS AND METHODS The catheter urine of 110 patients after RRP was macroscopically and microscopically examined and compared with the results of transrectal ultrasound and cystogram with regard to urine extravasation. RESULTS The examination of cloudy or bloody catheter urine indicated an extravasation in 32 of 33 cases (positive predictive value 97%; sensitivity 74%), for clear urine, there was sufficient anastomosis in 66 of 77 cases without any extravasation (negative predictive value 86%; specificity 99%). By performing a microscopic urine analysis unremarkable anastomosis was predicted only in 23 of 67 cases, which leads to a specificity of 34%. This shows that microscopic urine sediment is an inappropriate instrument to evaluate the anastomotic region. CONCLUSION In cases of macroscopic pathological urine findings, further diagnostics are not recommended; in 97% of the cases, extravasation is expected. The macroscopic urine examination sets a trend for other examinations like cystogram or dynamic transrectal ultrasound (dTRUS).
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Bachmann A. Editorial comment on: cold-knife incision of anastomotic strictures after radical retropubic prostatectomy with bladder neck preservation: efficacy and impact on urinary continence status. Eur Urol 2007; 54:654-5. [PMID: 18155823 DOI: 10.1016/j.eururo.2007.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hakenberg OW. Editorial comment on: cold-knife incision of anastomotic strictures after radical retropubic prostatectomy with bladder neck preservation: efficacy and impact on urinary continence status. Eur Urol 2007; 54:656. [PMID: 18155827 DOI: 10.1016/j.eururo.2007.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gallo L, Perdonà S, Autorino R, Menna L, Claudio L, Marra L, Di Lorenzo G, Gallo A. Vesicourethral Anastomosis During Radical Retropubic Prostatectomy: Does the Number of Sutures Matter? Urology 2007; 69:547-51. [PMID: 17382162 DOI: 10.1016/j.urology.2006.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 09/25/2006] [Accepted: 12/13/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To prospectively evaluate the outcome of radical retropubic prostatectomy using three different techniques of vesicourethral anastomosis (VUA), with a different number of sutures used during this surgical step. METHODS Three groups of patients who had undergone nerve-sparing radical retropubic prostatectomy were compared. Overall, 90 patients with localized prostate cancer were recruited. The patients were randomly assigned to undergo one of three different VUA techniques. The anastomotic sutures consisted of four or six monocryl 2-0 stitches. The "two-suture" anastomosis in group 1 was performed by passing two U-shaped horizontal stitches at the 6-o'clock and 12-o'clock positions. The following intraoperative and perioperative parameters were considered for the comparative analysis: time to perform VUA, blood loss, hospitalization, and time to drain removal. RESULTS A statistically significant difference was found in terms of the mean time to anastomosis between groups 1 and 2 (3.61 +/- 1.14 versus 16.6 +/- 4.04, P <0.0001) and between groups 1 and 3 (3.61 +/- 1.14 versus 23.45 +/- 5.4, P <0.0001). No significant differences could be detected for blood loss, time to drain removal, or hospitalization. No significant difference was detected in terms of functional outcome (stricture rate, erectile function, and continence). CONCLUSIONS The number of stitches used for VUA during radical retropubic prostatectomy did not influence the perioperative and postoperative parameters. The time to VUA was considerably lower using our "two-suture" technique.
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Affiliation(s)
- Luigi Gallo
- Department of Urology, National Cancer Institute Pascale Foundation, Naples, Italy.
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Abstract
Recombinant activated coagulation factor VII (rFVIIa) was developed initially for treatment of patients with hemophilia and neutralizing antibodies ("inhibitors") to coagulation factors VIII or IX. Owing to the unique and selective mechanism of action of rFVIIa and encouraged by clinical experience with other circumstances of inadequate hemostasis, a broad development program has been pursued to test potential efficacy and evaluate safety of this biologic for indications other than hemophilia. This review summarizes the current development of rFVIIa, focusing on results of prospective, randomized clinical trials.
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Affiliation(s)
- R B Weiskopf
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsvaerd, Denmark.
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