PTU - Polskie Towarzystwo Urologiczne
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THE OWN EXPERIENCE IN THE TREATMENT OF STRICTURES OF VESICOURETHRAL ANASTOMOSIS AFTER RADICAL PROSTATECTOMIES
Article published in Urologia Polska 1997/50/3.

authors

Romuald Zdrojowy
Katedra i Klinika Urologii AM we Wroc³awiu
Kierownik Kliniki: prof. dr hab. med. Jerzy Lorenz

keywords

prostate cancer radical prostatectomy vesicourethral anastomosis stricture

summary

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
ambulatory.
Conclusion. The optical urethrotomy is the efficacious and safe procedure
in the treatment of the vesicourethral anastomotic stricture after radical
prostatectomy.

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