Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
World J Urol. 2017 Dec;35(12):1885-1890. doi: 10.1007/s00345-017-2067-8. Epub 2017 Jul 3.
To re-evaluate safety and efficacy of transperineal reanastomosis (TPRA) as a viable therapeutic option in highly recurrent anastomotic strictures (AS) after radical retropubic prostatectomy (RRP).
Retrospective analysis by standardized questionnaire inquiring for recurrence of stricture, stress urinary incontinence (SUI), sexual function, satisfaction, and changes in quality of life (QoL) was performed in all patients undergoing TPRA. Validated questionnaires (ICIQ-UI, EQ-5D, and IPSS) were included.
Median follow-up was 45.0 months. The average number of prior operations was 4.69. Success rate was 87% (20/23). Three recurrences were successfully treated via endoscopic means. All patients had urinary incontinence pre-op and post-op. Implantation of an artificial urinary sphincter (AUS) has been performed successfully in 73.9% (17/23). Rate of complications was low (8.7%; 2/23, Clavien-Dindo Grade II + III). EQ-5D-VAS showed a good general state of health (73.5/100). An improvement in QoL was noted in 63.6% (14/22) and patient satisfaction was high (72.7%; 16/22).
This extended follow-up confirms the initial results for TPRA as an excellent treatment option for highly recurrent AS after RRP. Postoperative SUI as a consequence of transsphincteric urethral mobilization can be satisfactorily treated by the implantation of AUS. In case of AS recalcitrant to endoscopic treatment, the described procedure-even though technically challenging-represents a valuable treatment option.
重新评估经会阴吻合口再吻合术（TPRA）作为根治性耻骨后前列腺切除术（RRP）后高度复发性吻合口狭窄（AS）的一种可行治疗选择的安全性和疗效。
通过标准化问卷对所有接受 TPRA 的患者进行回顾性分析，询问狭窄、压力性尿失禁（SUI）、性功能、满意度以及生活质量（QoL）变化的复发情况。包括经过验证的问卷（ICIQ-UI、EQ-5D 和 IPSS）。
中位随访时间为 45.0 个月。平均手术次数为 4.69 次。成功率为 87%（20/23）。3 例复发患者通过内镜治疗成功。所有患者术前和术后均有尿失禁。23 例患者中有 73.9%（17/23）成功植入人工尿道括约肌（AUS）。并发症发生率低（8.7%；2/23，Clavien-Dindo 分级 II+III）。EQ-5D-VAS 显示健康状况良好（73.5/100）。63.6%（14/22）的患者 QoL 得到改善，患者满意度高（72.7%；16/22）。
这项扩展随访证实了 TPRA 作为 RRP 后高度复发性 AS 的初始治疗选择的良好效果。经括约肌尿道松解术后出现的 SUI 可以通过植入 AUS 得到满意的治疗。如果 AS 对内镜治疗有抗性，那么所描述的手术-尽管技术上具有挑战性-代表了一种有价值的治疗选择。
