The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study

ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

背景：耻骨后根治性前列腺切除术（retropubic radical prostatectomy, RRP）后并发膀胱尿道吻合口狭窄（vesicourethral anastomotic stenosis, VUAS）可显著降低患者生活质量。目的：探究增生性瘢痕形成与膀胱尿道吻合口狭窄（Vesicourethral anastomotic stenosis, VUAS）的关联，并筛选更适宜的手术干预方案以预防复发性膀胱尿道吻合口狭窄。研究设计与研究场所：本研究为一项覆盖2009年1月至2019年12月数据的单中心回顾性横断面研究。研究方法：本研究纳入573例因前列腺癌接受耻骨后根治性前列腺切除术（retropubic radical prostatectomy, RRP）的男性患者，其中80例确诊膀胱尿道吻合口狭窄（Vesicourethral anastomotic stenosis, VUAS）。根据治疗方式将患者分为两组：采用Amplatz肾扩张器（Amplatz renal dilators）行扩张术组（39例）；内镜下膀胱颈切开/切除术组（41例）。采用温哥华瘢痕量表（Vancouver scar scale, VSS）对膀胱尿道吻合口狭窄发生前各类原因所致瘢痕的特征进行评估。研究结果：术后中位随访时长为72个月（范围12~105个月），共有17例（21.3%）患者出现膀胱尿道吻合口狭窄复发。两组治疗成功率相近（79.5% vs 78.0%；P=0.875），但受试者工作特征（receiver operating characteristic, ROC）曲线分析显示，对于温哥华瘢痕量表（Vancouver scar scale, VSS）评分为4、5、6分的患者，采用Amplatz肾扩张器行扩张术相较于内镜下膀胱颈切开/切除术，可显著降低膀胱尿道吻合口狭窄复发风险。温哥华瘢痕量表评分与膀胱尿道吻合口狭窄发作总次数呈强正相关（r=0.689；P<0.001）。温哥华瘢痕量表评分（比值比（odds ratio, OR）=5.380；P<0.001）及膀胱尿道吻合口狭窄首次发作时长（OR=1.628；P=0.008）是预测膀胱尿道吻合口狭窄复发的最显著因素。研究结论：温哥华瘢痕量表评分可作为筛选适宜手术干预方案的预测工具，用于预防复发性膀胱尿道吻合口狭窄。