Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy

ABSTRACT Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 – 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 – 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. Conclusion: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.摘要 目的：评估基于术前尿控状态采用不同术式行开放性膀胱尿道再吻合术后的安全性、有效性及功能预后。 材料与方法：本研究为回顾性分析，纳入2002年至2017年间因根治性前列腺切除术（radical prostatectomy, RP）后出现膀胱尿道吻合口狭窄（vesicourethral anastomosis stricture, VUAS）且经内镜治疗失败、随访时长至少3个月的患者。将根治性前列腺切除术后尿控良好与尿失禁患者分别分配至经腹入路（abdominal approach, AA）与经会阴入路（perineal approach, PA）。记录患者人口学特征与围手术期变量。随访采用每4个月一次的临床访谈、尿流率测定及膀胱镜检查完成。手术成功定义为患者无相关临床症状，且尿道腔可通过14F软性膀胱镜。 结果：2002年至2017年间，共20例因根治性前列腺切除术后膀胱尿道吻合口狭窄接受开放性膀胱尿道再吻合术的患者纳入本研究。患者平均年龄为63.7岁（标准差1.4），中位随访时长为10个月（范围3~112个月）。术式分布为经会阴入路组10例（50%），经腹入路组10例（50%）。两组患者的平均手术时长为246.2±35.8分钟，中位住院时长为4天（范围2~10天），组间无显著差异。未观察到显著并发症发生率。经腹入路组中有3例患者出现步态障碍，预后良好且无后遗症。预估2年初级手术成功率为80%。初次手术后，89.9%的患者未再出现狭窄。随访期间，所有经会阴入路组患者均维持尿失禁状态，而经腹入路组中有90%的患者维持尿控良好。 结论：开放性膀胱尿道再吻合术是根治性前列腺切除术后复发性膀胱尿道吻合口狭窄的合理治疗选择。经会阴入路组所有患者术后均维持尿失禁状态，而经腹入路组的尿失禁发生率相对较低。