Yildirim Asif, Basok Erem Kaan, Ilhan Ali Ihsan, Basaran Adnan, Rifaioglu Mehmet Murat, Tokuc Resit
Department of Urology, SB Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey.
Int Urol Nephrol. 2008;40(3):667-73. doi: 10.1007/s11255-007-9309-4. Epub 2007 Dec 19.
Anastomotic stricture (AS) is a well-described complication of radical retropubic prostatectomy (RRP) despite all the refinements in surgical technique. We aimed to define and discuss the role of postoperative urinary drainage on AS development.
A total of 136 patients with localized prostate carcinoma underwent RRP. In all patients, urethral catheter was removed 3 weeks after RRP without a cystogram. We documented duration of drainage (<3 days, n=86; 3-5 days, n=36; and >5 days, n=14), volume of drainage (<300 ml, n=78; 300-500 ml, n=27; and >500 ml, n=31), and mean volume of drainage per day (<100 ml, n=85 and >100 ml, n=51), continence status, and clinical and histopathological characteristics of patients as risk factors related with AS.
AS was diagnosed in 28.6% of patients. The rate was found to be 35.9%, 41%, and 23.1%, consistent with duration, and 38.4%, 15.4%, and 46.2% according to volume of drainage, respectively (P=0.0001). AS occurred in 43.6% and 56.4% of patients concerning mean volume of drainage per day, respectively (P=0.007). Analysis showed that AS was significantly associated with duration (>3 days), total volume (>500 ml), and the mean volume (>100 ml) of urinary drainage among the variables. The rates of urinary incontinence were 30.7% in patients with AS and 6.2% in patients without AS.
Time and the amount of urinary drainage were significantly associated with stricture formation following RRP that might be caused by partial disruption of the anastomosis.
尽管手术技术不断改进，但吻合口狭窄（AS）仍是耻骨后根治性前列腺切除术（RRP）一种广为人知的并发症。我们旨在明确并讨论术后尿液引流在AS发生中的作用。
共有136例局限性前列腺癌患者接受了RRP手术。所有患者在RRP术后3周拔除尿道导管，未进行膀胱造影。我们记录了引流持续时间（<3天，n = 86；3 - 5天，n = 36；>5天，n = 14）、引流量（<300 ml，n = 78；300 - 500 ml，n = 27；>500 ml，n = 31）、每日平均引流量（<100 ml，n = 85；>100 ml，n = 51）、控尿状态以及患者的临床和组织病理学特征，将其作为与AS相关的危险因素。
28.6%的患者被诊断为AS。根据引流持续时间，该发生率分别为35.9%、41%和23.1%；根据引流量，分别为38.4%、15.4%和46.2%（P = 0.0001）。根据每日平均引流量，AS分别发生在43.6%和56.4%的患者中（P = 0.007）。分析表明，在这些变量中，AS与引流持续时间（>3天）、总引流量（>500 ml）和每日平均引流量（>100 ml）显著相关。AS患者的尿失禁发生率为30.7%，无AS患者为6.2%。
RRP术后狭窄形成与尿液引流的时间和量显著相关，这可能是由于吻合口部分破裂所致。
