Presented by: Joerg Neymeyer Dr.
Medical University Charite - Berlin - Department of Urology

Introduction

The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5-8% of patients after radical prostatectomy. Classic anastomosis resection alone carries the risk of recurrent stenosis. Improved modified high-precision stricture opening and subsequent continence-preserving stent placement should reduce restenosis rates and minimise damage to the sphincter.

Materials

From 01/2018 till 01/2023 36 patients with vesicourethral anastomosis stricture who underwent a radical prostatectomy (DaVinci RPX n=14, Laparoscopic RPX n=4, retropubic RPX n=18) were treated with modified high-precision stricture opening carfully without damaging the sphincter muscle by using a monopolar hook or wire electrode. For subsequent healing and to reduce re-stenosis to provides wide lumen opening, a continence-preserving stent placement (RPS stent 3cm or 4cm) was inserted. We looked at the incidence of anastomotic re-strictures. The diagnostic workup is similar to the procedure for typically vesicourethral anastomosis stricture. In addition to clinical examination, questionaire, urethrocystoscopy, uroflowmetry, perineal- and transrectal ultrasound, a cystourethrogram or, if necessary, a micturating cystourethrogram can be performed.

Results

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Patient age (54-81, mean age =72.3). Based on prospective X-ray studies, we were able to show that the site of stricture is located below the bladder neck musculature in most cases well above the distal urethral sphincter and pelvic floor. Stent length of stay (28-314 days, mean length of stay =131.8d around 4 months). No continence problems were encountered in a follow-up of 12-72 months determined by a questionnaire and clinical examination. An anastomotic re-stricture was found in 7 cases requiring the same endoscopic treatment again.

Conclusion

Endourological procedure by using monopolar stricture opening and healing stent insertion are a good treatment option. The protective large-lumen sealing polymer coating of the stent minimised restenosis by improving tissue healing.

Funding

none

Lead Authors

Alkan Cubuk, MD
Kocaeli University Hospital - Department of Urology

Sarah Weinberger, Dr.
Medical University Charite - Berlin - Department of Urology

Viktoria Schaeff, Dr.
Medical University Charite - Berlin - Department of Urology

Katharina Mala, Dr.
Medical University Charite - Berlin - Department of Urology

Thorsten Schlomm, Prof.
Medical University Charite - Berlin - Department of Urology