Portal de Periódicos da CAPES

ANASTOMOTIC CONTRACTURE AND INCONTINENCE AFTER RADICAL PROSTATECTOMY: A GRADED APPROACH TO MANAGEMENT

2005; Lippincott Williams & Wilkins; Volume: 173; Issue: 4 Linguagem: Inglês

10.1097/01.ju.0000155624.48337.a5

1527-3792

Jennifer T. Anger, Ganesh V. Raj, Fernando C. Delvecchio, George D. Webster,

Ureteral procedures and complications

No AccessJournal of UrologyAdult Urology: Oncology: Prostate/Testis/Penis/Urethra1 Apr 2005ANASTOMOTIC CONTRACTURE AND INCONTINENCE AFTER RADICAL PROSTATECTOMY: A GRADED APPROACH TO MANAGEMENT JENNIFER TASH ANGER, GANESH V. RAJ, FERNANDO C. DELVECCHIO, and GEORGE D. WEBSTER JENNIFER TASH ANGERJENNIFER TASH ANGER More articles by this author , GANESH V. RAJGANESH V. RAJ More articles by this author , FERNANDO C. DELVECCHIOFERNANDO C. DELVECCHIO More articles by this author , and GEORGE D. WEBSTERGEORGE D. WEBSTER Financial interest and/or other relationship with Lifetech. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000155624.48337.a5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present a heterogeneous group of men presenting with varying degrees of anastomotic contracture (AC) and associated stress urinary incontinence (SUI) following radical prostatectomy. It is particularly important that AC should be resolved before artificial urinary sphincter (AUS) implantation, because instrumentation through the AUS can risk erosion. Materials and Methods: The records of 54 consecutive men who were referred for the management of AC and associated SUI were reviewed. Patient treatment and outcomes were stratified according to their unique characteristics. Results: A total of 54 patients underwent radical prostatectomy alone (48), or in combination with radiation therapy (7) or cryotherapy (1). In group 1, 35 patients had previously undiscovered AC, or 1 or more prior contracture incisions (CIs) with SUI. CI and AUS were performed simultaneously in 33 patients and sequentially in 2. In group 2, 7 patients with intractable AC following multiple CIs/dilations and self-calibration, or an indwelling urethral or suprapubic catheter underwent simultaneous (3) or sequential (2) CI/AUS or CI only (2). Five patients required temporary self-calibration. In group 3, in 12 patients with total outlet obliteration recanalization was accomplished with combined antegrade/retrograde endoscopy and CI. Ten patients had re-obliteration, of whom 1 underwent suprapubic diversion and 9 underwent repeat recanalization with placement of a UroLume stent (American Medical Systems, Minnetonka, Minnesota) across the anastomosis. Eight patients underwent artificial urinary sphincter (AUS) placement 4 to 6 weeks later and 1 awaits an AUS. Of those implanted with an AUS 2 required repeat endoscopic procedures because of recurrent but manageable stent ingrowth. Conclusions: Most ACs are treated successfully with simultaneous, aggressive CI/AUS. A history of many CIs or long, dense contractures suggest the need for staged management. In those with obliterated outlets we prefer to reestablish patency and if rapid recurrence develops, we place a UroLume stent. Regardless of a history of radiation therapy, continence is restored with an AUS. References 1 : Prostate cancer trends in the era of prostate-specific antigen. An update of incidence, mortality, and clinical factors from the SEER database. Urol Clin North Am2002; 29: 173. Google Scholar 2 : Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium. J Urol1998; 160: 1373. Link, Google Scholar 3 : Preoperative and operative factors to predict incontinence, impotence and stricture after radical prostatectomy. Prostate Cancer Prostatic Dis1998; 1: 242. Google Scholar 4 : Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol2000; 163: 858. Link, Google Scholar 5 : Endoscopic evaluation and treatment of anastomotic strictures after radical retropubic prostatectomy. J Urol1996; 155: 206. Link, Google Scholar 6 : Combined stent and artificial sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol2001; 165: 413. Link, Google Scholar 7 : Anastomotic strictures following radical prostatectomy: risk factors and management. J Urol1990; 143: 755. Link, Google Scholar 8 : Endoscopic management of the obliterated anastomosis following radical prostatectomy. J Urol1996; 156: 70. Link, Google Scholar 9 : Synchronous management of anastomotic contracture and stress urinary incontinence following radical prostatectomy. J Urol1994; 151: 1202. Link, Google Scholar 10 : Treatment of anastomotic strictures and urinary incontinence after radical prostatectomy with urolume wallstent and AMS 800 artificial sphincter. J Endourol1999; 13: 517. Google Scholar 11 : Epithelialization of permanent stents. J Endourol1997; 11: 477. Google Scholar 12 : Repair of obliterative vesicourethral stricture after radical prostatectomy: a technique for preservation of continence. Urology1995; 45: 510. Google Scholar 13 : Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures. Eur Urol2000; 38: 734. Google Scholar 14 : Successful outcome of artificial urinary sphincters in men with post-prostatectomy urinary incontinence despite adverse implantation features. J Urol1992; 148: 1166. Link, Google Scholar From the Division of Urology, Duke University Medical Center, Durham, North Carolina© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKrughoff K and Peterson A (2023) Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary SphincterJournal of Urology, VOL. 209, NO. 5, (981-991), Online publication date: 1-May-2023.LaBossiere J, Cheung D and Rourke K (2015) Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of SuccessJournal of Urology, VOL. 195, NO. 5, (1495-1500), Online publication date: 1-May-2016.Liberman D, Jarosek S, Virnig B, Chu H and Elliott S (2015) The Patient Burden of Bladder Outlet Obstruction after Prostate Cancer TreatmentJournal of Urology, VOL. 195, NO. 5, (1459-1463), Online publication date: 1-May-2016.Nagpal K, Zinman L, Lebeis C, Vanni A and Buckley J (2015) Durable Results of Mitomycin C Injection with Internal Urethrotomy for Refractory Bladder Neck Contractures: Multi-institutional ExperienceUrology Practice, VOL. 2, NO. 5, (250-255), Online publication date: 1-Sep-2015.Pfalzgraf D, Beuke M, Isbarn H, Reiss C, Meyer-Moldenhauer W, Dahlem R and Fisch M (2011) Open Retropubic Reanastomosis for Highly Recurrent and Complex Bladder Neck StenosisJournal of Urology, VOL. 186, NO. 5, (1944-1947), Online publication date: 1-Nov-2011.Vanni A, Zinman L and Buckley J (2011) Radial Urethrotomy and Intralesional Mitomycin C for the Management of Recurrent Bladder Neck ContracturesJournal of Urology, VOL. 186, NO. 1, (156-160), Online publication date: 1-Jul-2011.Anger J (2010) Management of Recalcitrant Bladder Neck Contracture After Radical Prostatectomy for Prostate CancerJournal of Urology, VOL. 185, NO. 2, (391-392), Online publication date: 1-Feb-2011.Erickson B, McAninch J, Eisenberg M, Washington S and Breyer B (2010) Management for Prostate Cancer Treatment Related Posterior Urethral and Bladder Neck Stenosis With StentsJournal of Urology, VOL. 185, NO. 1, (198-203), Online publication date: 1-Jan-2011.Magera J, Inman B and Elliott D (2009) Outcome Analysis of Urethral Wall Stent Insertion With Artificial Urinary Sphincter Placement for Severe Recurrent Bladder Neck Contracture Following Radical ProstatectomyJournal of Urology, VOL. 181, NO. 3, (1236-1241), Online publication date: 1-Mar-2009.Eisenberg M, Elliott S and McAninch J (2008) Management of Restenosis After Urethral Stent PlacementJournal of Urology, VOL. 179, NO. 3, (991-995), Online publication date: 1-Mar-2008.Eisenberg M, Elliott S and McAninch J (2007) Preservation of Lower Urinary Tract Function in Posterior Urethral Stenosis: Selection of Appropriate Patients for Urethral StentsJournal of Urology, VOL. 178, NO. 6, (2456-2461), Online publication date: 1-Dec-2007.Lai H, Hsu E, Teh B, Butler E and Boone T (2018) 13 Years of Experience With Artificial Urinary Sphincter Implantation at Baylor College of MedicineJournal of Urology, VOL. 177, NO. 3, (1021-1025), Online publication date: 1-Mar-2007.Raj G, Peterson A and Webster G (2018) Outcomes Following Erosions of the Artificial Urinary SphincterJournal of Urology, VOL. 175, NO. 6, (2186-2190), Online publication date: 1-Jun-2006. Volume 173Issue 4April 2005Page: 1143-1146 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsurethraprostatectomypostoperative complicationsurinary incontinence, stressbladderMetricsAuthor Information JENNIFER TASH ANGER More articles by this author GANESH V. RAJ More articles by this author FERNANDO C. DELVECCHIO More articles by this author GEORGE D. WEBSTER Financial interest and/or other relationship with Lifetech. More articles by this author Expand All Advertisement PDF downloadLoading ...