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Die Striktur der vesikourethralen Anastomose nach radikaler Prostatektomie

Stricture of the vesicourethral anastomosis after radical prostatectomy

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Zusammenfassung

Hintergrund

Die Striktur der vesikourethralen Anastomose ist eine schwerwiegende Komplikation nach radikaler Prostatektomie. Bisher konnten keine eindeutigen klinischen Faktoren für die Entstehung einer Anastomosenstriktur sicher eruiert werden. Eine Striktur der vesikourethralen Anastomose tritt bei ca. 5–8 % aller Prostatektomiepatienten auf.

Symptomatik

Die klinische Symptomatik zeigt meist, ähnlich wie bei der benignen Prostatahyperplasie, eine irritative oder obstruktive Komponente. Selten kommt es in Folge einer Anastomosenstriktur zur Ausbildung einer teilweisen oder kompletten Belastungsinkontinenz.

Diagnostik

Die Diagnostik orientiert sich im Wesentlichen dem Vorgehen bei Harnröhrenstrikturen. Neben einer Uroflowmetrie sowie Restharnbestimmung kann zur weiteren Abklärung ein Zystourethrogramm ggf. eine Miktionszystourethrographie durchgeführt werden. Sollte hierbei keine eindeutige Diagnose gesichert werden, kann eine Urethrozystoskopie Sicherheit schaffen.

Therapie

Meistens werden endoskopische Verfahren als operative Therapie durchgeführt. Hierbei wird neben der Sachse-Urethrotomie oder einer Dilatation meistens eine transurethrale Resektion der Anastomose vorgenommen. Alle Verfahren zeigen jedoch eine hohe Rezidivquote. Bei rezidivierenden Strikturen können offen-operative Verfahren und hierbei meistens perineale Reanastomosen durchgeführt werden.

Schlussfolgerung

Endourologische Verfahren stellen eine gute Therapieoption dar. Aufgrund der hohen Rezidivquoten sollten offen-operative Verfahren frühzeitig angeboten und ggf. durchgeführt werden.

Abstract

Background

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.

Symptoms

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.

Diagnostics

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.

Therapy

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.

Conclusion

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.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland

    V. Beck, M. Apfelbeck, M. Chaloupka, A. Kretschmer, F. Strittmatter & S. Tritschler

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  1. V. Beck
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  2. M. Apfelbeck
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  3. M. Chaloupka
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Correspondence to V. Beck.

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Interessenkonflikt

V. Beck, M. Apfelbeck, M. Chaloupka, A. Kretschmer, F. Strittmatter und S. Tritschler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Beck, V., Apfelbeck, M., Chaloupka, M. et al. Die Striktur der vesikourethralen Anastomose nach radikaler Prostatektomie. Urologe 57, 29–33 (2018). https://doi.org/10.1007/s00120-017-0550-x

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