Britton Cameron J, Sharma Vidit, Fadel Anthony E, Bearrick Elizabeth, Findlay Bridget L, Frank Igor, Tollefson Matthew K, Karnes R Jeffrey, Viers Boyd R
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2023 Aug;210(2):312-322. doi: 10.1097/JU.0000000000003488. Epub 2023 Apr 20.
Vesicourethral anastomotic stenosis after radical prostatectomy is a complication with significant adverse quality-of-life implications. Herein, we identify groups at risk for vesicourethral anastomotic stenosis and further characterize the natural history and treatment patterns.
Years 1987-2013 of a prospectively maintained radical prostatectomy registry were queried for patients with the diagnosis of vesicourethral anastomotic stenosis, defined as symptomatic and inability to pass a 17F cystoscope. Patients with follow-up less than 1 year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of vesicourethral anastomotic stenosis. Functional outcomes were characterized.
Out of 17,904 men, 851 (4.8%) developed vesicourethral anastomotic stenosis at a median of 3.4 months. Multivariable logistic regression identified associations with vesicourethral anastomotic stenosis including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and nonnerve-sparing techniques. Robotic approach (OR 0.39, < .01) and complete nerve sparing (OR 0.63, < .01) were associated with reduced vesicourethral anastomotic stenosis formation. Vesicourethral anastomotic stenosis was independently associated with 1 or more incontinence pads/d at 1 year (OR 1.76, < .001). Of the patients treated for vesicourethral anastomotic stenosis, 82% underwent endoscopic dilation. The 1- and 5-year vesicourethral anastomotic stenosis retreatment rates were 34% and 42%, respectively.
Patient-related factors, surgical technique, and perioperative morbidity influence the risk of vesicourethral anastomotic stenosis after radical prostatectomy. Ultimately, vesicourethral anastomotic stenosis is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men, with a high rate of retreatment by 5 years.
根治性前列腺切除术后膀胱尿道吻合口狭窄是一种对生活质量有重大不良影响的并发症。在此，我们确定膀胱尿道吻合口狭窄的高危人群，并进一步描述其自然病史和治疗模式。
查询1987 - 2013年前瞻性维护的根治性前列腺切除术登记册中诊断为膀胱尿道吻合口狭窄的患者，定义为有症状且无法通过17F膀胱镜。排除随访时间少于1年、术前前尿道狭窄、经尿道前列腺切除术、既往盆腔放疗和转移性疾病的患者。进行逻辑回归以确定膀胱尿道吻合口狭窄的预测因素。对功能结局进行了描述。
在17904名男性中，851名（4.8%）在中位时间3.4个月时发生膀胱尿道吻合口狭窄。多变量逻辑回归确定与膀胱尿道吻合口狭窄相关的因素包括辅助放疗、体重指数、前列腺体积、尿漏、输血和非保留神经技术。机器人手术方式（比值比0.39，P <.01）和完全保留神经（比值比0.63，P <.01）与膀胱尿道吻合口狭窄形成减少相关。膀胱尿道吻合口狭窄与1年时每天使用1个或更多尿失禁垫独立相关（比值比1.76，P <.001）。在接受膀胱尿道吻合口狭窄治疗的患者中，82%接受了内镜扩张。1年和5年膀胱尿道吻合口狭窄再治疗率分别为34%和42%。
患者相关因素、手术技术和围手术期发病率影响根治性前列腺切除术后膀胱尿道吻合口狭窄的风险。最终，膀胱尿道吻合口狭窄与尿失禁风险增加独立相关。内镜治疗对大多数男性来说只是暂时的，5年时再治疗率很高。
