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Surgical Reconstruction of Posterior Urethral Complications Following Prostate Cancer Treatments

  • Malte W. VetterleinEmail author
  • Clemens M. Rosenbaum
  • Margit Fisch
Chapter

Abstract

Surgical or non-surgical treatment of prostate cancer is commonly associated with mid- or long-term complications, such as urethral stenoses, vesico-urethral anastomotic stenoses, or urorectal fistulae. Although such complications are relatively rare, they have significant impact on a patient’s quality of life. Within this book chapter, we aimed to review contemporary therapeutical approaches for those complications and sequelae following prostate cancer treatment.

Whereas mainly endoscopic treatment approaches (transurethral resection, photoselective vaporization) are available for prostatic urethral stenosis after radiotherapy, the surgical armamentarium for vesico-urethral anastomotic stenosis after radical prostatectomy includes both endoscopic and open surgical reconstructive options. Initial treatment in such cases may include dilation, incision or transurethral resection. In treatment-refractory stenoses, open reconstruction via an abdominal (retropubic), perineal or combined abdominoperineal approach may be performed. Patients undergoing open reanastomosis are commonly incontinent after surgery and may need subsequent artificial urinary sphincter implantation.

For surgical reconstruction of urorectal fistulae, mainly four approaches are available, including a transperineal, transabdominal (or combined), trans-ano-rectal sphincter-splitting, and a peranal approach. Abdominoperineal approaches are often favored by urologists, given that the urinary tract and the rectum may be reconstructed separately and interposition flaps may be used to minimize the recurrence risk. However, compared to trans-ano-rectal or peranal approaches, morbidity is often higher, recovery is longer, and a reconstruction of the vesico-urethral anastomosis is needed. Thus, minimally-invasive approaches are commonly preferred by colorectal surgeons.

Arguably, complications following radical prostatectomy are different from those following radiotherapy, as the latter commonly develop later after initial therapy and are associated with greater morbidity and more complex reconstruction. However, in each case there are therapeutic options available to improve patient satisfaction and health-related quality of life.

Keywords

Prostatectomy Radiotherapy Rectal fistula Urinary bladder neck obstruction Urinary fistula 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Malte W. Vetterlein
    • 1
    Email author
  • Clemens M. Rosenbaum
    • 1
  • Margit Fisch
    • 1
  1. 1.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany

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