Departments of Urology, University Hospital Hamburg-Eppendorf and Asklepios Clinic Hamburg-Harburg, WHMM, Hamburg, Germany.
J Urol. 2011 Nov;186(5):1944-7. doi: 10.1016/j.juro.2011.07.040. Epub 2011 Sep 23.
We assessed the success rate of open reanastomosis for highly recurrent bladder neck stenosis resistant to transurethral treatment. Due to the paucity of available data the success rate of this procedure is not well defined, although it can be a last treatment option before urinary diversion.
A total of 158 patients were treated for bladder neck stenosis in 1998 to 2007, of whom 20 underwent open reanastomosis for highly recurrent or complex bladder neck stenosis after radical prostatectomy and were seen for followup 3 months postoperatively. They received a standardized questionnaire at the time of data acquisition in this retrospective analysis.
The 20 patients underwent a mean of 3.7 previous surgeries. Median followup was 59.2 months. Stenosis recurred after reanastomosis in 8 patients (40%) while the remaining 60% were recurrence free. Seven recurrences were successfully treated endoscopically, resulting in an overall combined 95% success rate. Urinary diversion was performed in 1 patient with another recurrence after reanastomosis and transurethral resection. Four patients (31%) had new onset incontinence and 13 were completely incontinent, of whom 9 were successfully treated with artificial urinary sphincter implantation. In another patient artificial urinary sphincter implantation is scheduled and 3 elected no further treatment.
Open reanastomosis for recurrent bladder neck stenosis is a good therapeutic option in cases of endoscopic treatment failure. The initial success rate after reanastomosis was 60%, which increased to 95% after secondary treatment. There was a relatively high risk of new onset incontinence after reconstructive surgery but this was successfully treated with artificial urinary sphincter implantation in most patients.
我们评估了经尿道治疗抵抗的高度复发性膀胱颈狭窄的开放再吻合术的成功率。由于可用数据的缺乏，该手术的成功率尚未明确，尽管它可能是尿流改道前的最后一种治疗选择。
1998 年至 2007 年，共有 158 例患者接受了膀胱颈狭窄治疗，其中 20 例接受了根治性前列腺切除术后高度复发性或复杂膀胱颈狭窄的开放再吻合术，并在术后 3 个月进行了随访。在这项回顾性分析中，他们在数据采集时接受了标准化问卷。
20 例患者平均接受了 3.7 次先前的手术。中位随访时间为 59.2 个月。再吻合术后 8 例（40%）出现狭窄复发，而其余 60%的患者无复发。7 例复发患者经内镜治疗成功，总成功率为 95%。1 例患者因再吻合术后和经尿道切除术后再次复发而进行了尿流改道。4 例（31%）患者新发尿失禁，13 例完全失禁，其中 9 例通过人工尿道括约肌植入术成功治疗。另有 1 例患者计划进行人工尿道括约肌植入术，3 例患者选择不再进一步治疗。
对于内镜治疗失败的复发性膀胱颈狭窄，开放再吻合术是一种良好的治疗选择。再吻合术后的初始成功率为 60%，经二次治疗后增加至 95%。重建手术后新发尿失禁的风险相对较高，但大多数患者通过人工尿道括约肌植入术成功治疗。
