Beck V, Apfelbeck M, Chaloupka M, Kretschmer A, Strittmatter F, Tritschler S
Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.
Urologe A. 2018 Jan;57(1):29-33. doi: 10.1007/s00120-017-0550-x.
The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5-8% of patients after radical prostatectomy.
Usually the clinical symptoms include an irritative and obstructive component similar to benign prostatic hyperplasia. In rare cases, patients suffer from partial or complete stress incontinence as a result of the anastomotic stricture.
The diagnostic workup is similar to the procedure for urethral strictures. In addition to uroflowmetry, a cystourethrogram (CUG) or, if necessary, a micturating cystourethrogram (MCU) can be performed. A urethrocystoscopy can be performed to ensure the diagnosis.
In most cases, endoscopic procedures were performed for treatment. Beside a transurethral dilation of the stricture or the Sachse urethrotomy, the most common procedure is transurethral resection to treat the stricture. However, all procedures are associated with a high recurrence rate. In recurrent strictures, open surgical procedures, usually a perineal reanastomosis, should performed early.
Endourological procedures like transurethral resection are a good treatment option, but due to the high recurrence rates, open surgical procedures should be discussed and if necessary should be performed early.
膀胱尿道吻合口狭窄是根治性前列腺切除术后的一种严重并发症。根治性前列腺切除术后5 - 8%的患者会出现狭窄。
通常临床症状包括与良性前列腺增生相似的刺激症状和梗阻症状。在罕见情况下，患者会因吻合口狭窄而出现部分或完全性压力性尿失禁。
诊断检查与尿道狭窄的检查程序相似。除尿流率测定外，可进行膀胱尿道造影（CUG），必要时可进行排尿性膀胱尿道造影（MCU）。可进行尿道膀胱镜检查以确诊。
大多数情况下，采用内镜手术进行治疗。除了经尿道狭窄扩张术或萨克斯尿道切开术外，最常见的手术是经尿道切除术来治疗狭窄。然而，所有手术都有较高的复发率。对于复发性狭窄，应尽早进行开放性手术，通常是会阴重新吻合术。
像经尿道切除术这样的腔内泌尿外科手术是一种很好的治疗选择，但由于复发率高，应讨论开放性手术，必要时应尽早进行。
