THE OWN EXPERIENCE IN THE TREATMENT
OF STRICTURES OF VESICOURETHRAL ANASTOMOSIS
AFTER RADICAL PROSTATECTOMIES
Article published in Urologia Polska 1997/50/3.
- Katedra i Klinika Urologii AM we Wroc³awiu
Kierownik Kliniki: prof. dr hab. med. Jerzy Lorenz
prostate cancer radical prostatectomy vesicourethral anastomosis stricture
- 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
- Conclusion. The optical urethrotomy is the efficacious and safe procedure
- in the treatment of the vesicourethral anastomotic stricture after radical
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