PTU - Polskie Towarzystwo Urologiczne
list of articles:

Article published in Urologia Polska 1997/50/3.


Romuald Zdrojowy
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


  1. [1] Bodker, A., Ostri, R, Rye-Anderson, }., Edvardsen, L., Struckmann, J.:
  2. Treatment of recurrent urethral stricture by internal urethrotomy and intermittent
  3. self-catheterisation: a controlled study of a new therapy. J. Urol., 1992,148, 308.
  4. [2] Carr, L. K., Webster, G. D.: Endoscopic management of the obliterated anasto-
  5. mosis following radical prostatectomy. J. Urol., 1996, 156, 70-72.
  6. [3] Chiou, R. K., Gonzales, R., Ortlip, S., Fraley, E. E.: Endoscopic treatment
  7. of posterior urethral obliteration: long-term follow-up and Comparison with trans-
  8. pubic Urethroplasty. J. Urol., 1988,140, 508.
  9. [4] Chuang, C. K., Lai, M. K., Chu, S. H.: Optic internal urethrotomy under
  10. transrectal ultrasonographic guide and suprapubic fiberoscopic aid. J. Urol., 1994,
  11. 152, 1435.
  12. [5] Dalkin, B. L.: Endoscopic evaluation and treatment of anastomotic strictures
  13. after radical retropubic prostatectomy. J. Urol., 1996, 155, 206-208.
  14. [6] Igel, T. C, Barrett, B. M., Segura, J. W., Benson, R. C, Rife, C. C:
  15. Perioperative and postoperative complications from bilateral pehic lymphadenec-
  16. tomy and radical retropubic prostatectomy. J. Urol., 1987,137,1189.
  17. [7] Keetch, D. W., Andriole, G. L., Catalona, W. J.: Complications of radical
  18. retropubic prostatectomy. AUA Update Series, 1994,13, 6.
  19. [8] Kohrmann, K. U., Henkel, T. O., Schmidt, R, Rassweiler, J.: Antegrade-
  20. retrograde urethrotomy for treatment of severe strictures of the urethra: experience
  21. and literature reniew. J. Endourol., 1994, 8, 433.
  22. [9] Kulp, D., Gomella, L.: Transurethral contact laser incision (CLI) of bladder
  23. neck contractures. J. Urol., 1993, 149, part 2, 498A, 1141.
  24. [10] Lange, P. H., Reddy, P. K.: Technical nuances and surgical results of radical
  25. retropubic prostatectomy in 150 patients. J. Urol., 1987, 138, 348.
  26. [11] Leandri, P., Rossignol, G., Gautier, J. R., Ramon, J.: Radical retropubic
  27. prostatectomy morbidity and auality of life. Experience with 620 consecutive ca-
  28. ses. J. Urol., 1992, 147, part 2, 883.
  29. [12] Lieberman, S. R, Barry, J. M.: Retreat from transpubic Urethroplasty for oblit-
  30. erated membranous urethral strictures. J. Urol., 1988, 140, 508.
  31. [13] Mark, S., Perez, L. M., Webster, G. D.: Synchronous management of anasto-
  32. motic contracture and stress urinary incontinence following radical prostatecto-
  33. my. J. Urol., 1994,151,1202.
  34. [14] Newman, L. H., Stone, M. M., Chircus, J. H., Kramer, H. C.: Recurrent
  35. urethral stricture disease managed by clean intermittent self-catheterization. J.
  36. Urol., 1990, 144, 1142.
  37. [15] Ramchandani, R, Banner, M. R, Berlin, J. W., Dannenbaum, M. S.,
  38. Wein, A. J.: Vesicourethral anastomotic strictures after radical prostatectomy:
  39. efficacy of transurethral baloon dilatation. Radiology, 1994, 193, 345.
  40. [16] Schellhammer, R, Jordan, G., Schlossberg, S.: Transurethral baloon dilata-
  41. tion of anastomotic stricture after radical prostatectomy. Conterporary Urol.,
  42. 1994, 16.
  43. [17] Schlossberg, S., Jordan, G., Schellhammer, R: Repair of obliterative vesi-
  44. courethral stricture after radical prostatectomy: a techni±ue for presewation of
  45. continence. Urology, 1995, 45, 510.
  46. [18] Surya, B. V., Provet,)., Johanson, K. E., Brown, J.: Anastomotic strictures
  47. following radical prostatectomy: risk factors and management. J. Urol., 1990,143,
  48. 755.
  49. [19] Veenema, R. ]., Gursel, E. O., Lattimer, J. K.: Radical retropubic prostatec-
  50. tomy for cancer: a 20-years experience. J. Urol., 1977, 117, 330.
  51. [20] Walsh, R C., Retik, A. B., Stamey, T. A., Vaughan, E. D.: CampbelYs
  52. Urology. W. B. Saunders Co., Philadelphia, 1992, 2865-2886.
  53. [21] Webster, G. D., Sihelnik, S.; The management of strictures of the membranous
  54. urethra. ]. Urol., 1985, 134, 469.