Advertisement

Management of Vesicourethral Anastomotic Stricture

  • Yuka Yamaguchi
  • Lee C. ZhaoEmail author
  • Allen T. Morey
Chapter

Abstract

Anastomotic strictures or bladder neck contractures are an uncommon complication after radical prostatectomy. While the majority of men with bladder neck contractures are successfully treated endoscopically, a significant number require multiple procedures, and a subset requires open reconstruction. Open surgical repair of refractory bladder neck contracture is a challenging procedure that needs to be tailored to the individual. Careful consideration must be paid to preexisting post-prostatectomy incontinence and de novo incontinence after management of bladder neck contractures as this often requires concurrent or subsequent management with artificial urinary sphincter placement.

Keywords

Bladder neck contracture Anastomotic stricture Transurethral incision of bladder neck 

References

  1. 1.
    King T, Almallah YZ. Post-radical-prostatectomy urinary incontinence: the management of concomitant bladder neck contracture. Adv Urol. 2012;2012:295798.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Lange PH, Reddy PK. Technical nuances and surgical results of radical retropubic prostatectomy in 150 patients. J Urol. 1987;138(2):348–52.PubMedGoogle Scholar
  3. 3.
    Middleton AW. Pelvic lymphadenectomy with modified radical retropubic prostatectomy as a single operation: technique used and results in 50 consecutive cases. J Urol. 1981;125(3):353–6.PubMedGoogle Scholar
  4. 4.
    Davidson PJ, van den Ouden D, Schroeder FH. Radical prostatectomy: prospective assessment of mortality and morbidity. Eur Urol. 1996;29(2):168–73.PubMedGoogle Scholar
  5. 5.
    Fowler FJ, Barry MJ, Lu-Yao G, Roman A, Wasson J, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993). Urology. 1993;42(6):622–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Kao TC, Cruess DF, Garner D, Foley J, Seay T, Friedrichs P, et al. Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol. 2000;163(3):858–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Erickson BA, Meeks JJ, Roehl KA, Gonzalez CM, Catalona WJ. Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience. BJU Int. 2009;104(11):1615–9.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR, et al. Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE. J Urol. 2007;178(2):529–34. discussion 534.PubMedCrossRefGoogle Scholar
  9. 9.
    Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009;302(14):1557–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Breyer BN, Davis CB, Cowan JE, Kane CJ, Carroll PR. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. 2010;106(11):1734–8.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Williams SB, Prasad SM, Weinberg AC, Shelton JB, Hevelone ND, Lipsitz SR, et al. Trends in the care of radical prostatectomy in the United States from 2003 to 2006. BJU Int. 2011;108(1):49–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Mundy AR, Andrich DE. Posterior urethral complications of the treatment of prostate cancer. BJU Int. 2012;110(3):304–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Begg CB, Riedel ER, Bach PB, Kattan MW, Schrag D, Warren JL, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346(15):1138–44.PubMedCrossRefGoogle Scholar
  14. 14.
    Sandhu JS, Gotto GT, Herran LA, Scardino PT, Eastham JA, Rabbani F. Age, obesity, medical comorbidities and surgical technique are predictive of symptomatic anastomotic strictures after contemporary radical prostatectomy. J Urol. 2011;185(6):2148–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Borboroglu PG, Sands JP, Roberts JL, Amling CL. Risk factors for vesicourethral anastomotic stricture after radical prostatectomy. Urology. 2000;56(1):96–100.PubMedCrossRefGoogle Scholar
  16. 16.
    Levy JB, Ramchandani P, Berlin JW, Broderick GA, Wein AJ. Vesicourethral healing following radical prostatectomy: is it related to surgical approach? Urology. 1994;44(6):888–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Park R, Martin S, Goldberg JD, Lepor H. Anastomotic strictures following radical prostatectomy: insights into incidence, effectiveness of intervention, effect on continence, and factors predisposing to occurrence. Urology. 2001;57(4):742–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Surya BV, Provet J, Johanson KE, Brown J. Anastomotic strictures following radical prostatectomy: risk factors and management. J Urol. 1990;143(4):755–8.PubMedGoogle Scholar
  19. 19.
    Gotto GT, Yunis LH, Vora K, Eastham JA, Scardino PT, Rabbani F. Impact of prior prostate radiation on complications after radical prostatectomy. J Urol. 2010;184(1):136–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Dalkin BL. Endoscopic evaluation and treatment of anastomotic strictures after radical retropubic prostatectomy. J Urol. 1996;155(1):206–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156(5):1707–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Giannarini G, Manassero F, Mogorovich A, Valent F, De Maria M, Pistolesi D, et al. Cold-knife incision of anastomotic strictures after radical retropubic prostatectomy with bladder neck preservation: efficacy and impact on urinary continence status. Eur Urol. 2008;54(3):647–56.PubMedCrossRefGoogle Scholar
  23. 23.
    Popken G, Sommerkamp H, Schultze-Seemann W, Wetterauer U, Katzenwadel A. Anastomotic stricture after radical prostatectomy. Incidence, findings and treatment. Eur Urol. 1998;33(4):382–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Yurkanin JP, Dalkin BL, Cui H. Evaluation of cold knife urethrotomy for the treatment of anastomotic stricture after radical retropubic prostatectomy. J Urol. 2001;165(5):1545–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Anger JT, Raj GV, Delvecchio FC, Webster GD. Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management. J Urol. 2005;173(4):1143–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Ramirez D, Zhao LC, Bagrodia A, Scott JF, Hudak SJ, Morey AF. Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology. 2013;82(6):1430–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Breyer BN, McAninch JW. Management of recalcitrant bladder neck contracture after radical prostatectomy for prostate cancer. Endoscopic and open surgery. J Urol. 2011;185(2):390–1.PubMedCrossRefGoogle Scholar
  28. 28.
    Ramchandani P, Banner MP, Berlin JW, Dannenbaum MS, Wein AJ. Vesicourethral anastomotic strictures after radical prostatectomy: efficacy of transurethral balloon dilation. Radiology. 1994;193(2):345–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Schlossberg S, Jordan G, Schellhammer P. Repair of obliterative vesicourethral stricture after radical prostatectomy: A technique for preservation of continence. Urology. 1995;45(3):510–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Lubahn JD, Zhao LC, Scott JF, Hudak SJ, Chee J, Terlecki R, et al. Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol. 2014;191(1):143–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Lagerveld BW, Laguna MP, Debruyne FMJ, De La Rosette JJMCH. Holmium:YAG laser for treatment of strictures of vesicourethral anastomosis after radical prostatectomy. J Endourol. 2005;19(4):497–501.PubMedCrossRefGoogle Scholar
  32. 32.
    Hayashi T, Yoshinaga A, Ohno R, Ishii N, Watanabe T, Yamada T, et al. Successful treatment of recurrent vesicourethral stricture after radical prostatectomy with holmium laser: report of three cases. Int J Urol. 2005;12(4):414–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Westney OL. Salvage surgery for bladder outlet obstruction after prostatectomy or cystectomy. Curr Opin Urol. 2008;18(6):570–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Carr LK, Webster GD. Endoscopic management of the obliterated anastomosis following radical prostatectomy. J Urol. 1996;156(1):70–2.PubMedCrossRefGoogle Scholar
  35. 35.
    Dogra PN, Nabi G. Core-through urethrotomy using the neodymium: YAG laser for obliterative urethral strictures after traumatic urethral disruption and/or distraction defects: long-term outcome. J Urol. 2002;167(2 Pt 1):543–6.PubMedGoogle Scholar
  36. 36.
    Eltahawy E, Gur U, Virasoro R, Schlossberg SM, Jordan GH. Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injection. BJU Int. 2008;102(7):796–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Vanni AJ, Zinman LN, Buckley JC. Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures. J Urol. 2011;186(1):156–60.PubMedCrossRefGoogle Scholar
  38. 38.
    Milroy EJ, Chapple C, Eldin A, Wallsten H. A new treatment for urethral strictures: a permanently implanted urethral stent. J Urol. 1989;141(5):1120–2.PubMedGoogle Scholar
  39. 39.
    Corujo M, Badlani GH. Epithelialization of permanent stents. J Endourol Endourol Soc. 1997;11(6):477–80.CrossRefGoogle Scholar
  40. 40.
    Elliott DS, Boone TB. Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol. 2001;165(2):413–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Anger J. Management of recalcitrant bladder neck contracture after radical prostatectomy for prostate cancer. UroLume stent. J Urol. 2011;185(2):391–2.PubMedCrossRefGoogle Scholar
  42. 42.
    Erickson BA, McAninch JW, Eisenberg ML, Washington SL, Breyer BN. Management for prostate cancer treatment related posterior urethral and bladder neck stenosis with stents. J Urol. 2011;185(1):198–203.PubMedCrossRefGoogle Scholar
  43. 43.
    Magera Jr JS, Inman BA, Elliott DS. Outcome analysis of urethral wall stent insertion with artificial urinary sphincter placement for severe recurrent bladder neck contracture following radical prostatectomy. J Urol. 2009;181(3):1236–41.PubMedCrossRefGoogle Scholar
  44. 44.
    Wessells H, Morey AF, McAninch JW. Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium. J Urol. 1998;160(4):1373–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Simonato A, Gregori A, Lissiani A, Varca V, Carmignani G. Use of Solovov-Badenoch principle in treating severe and recurrent vesico-urethral anastomosis stricture after radical retropubic prostatectomy: technique and long-term results. BJU Int. 2012;110(11 Pt B):E456–60.PubMedCrossRefGoogle Scholar
  46. 46.
    Theodoros C, Katsifotis C, Stournaras P, Moutzouris G, Katsoulis A, Floratos D. Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures. Eur Urol. 2000;38(6):734–40. discussion 740–1.PubMedCrossRefGoogle Scholar
  47. 47.
    Elliott SP, McAninch JW, Chi T, Doyle SM, Master VA. Management of severe urethral complications of prostate cancer therapy. J Urol. 2006;176(6 Pt 1):2508–13.PubMedCrossRefGoogle Scholar
  48. 48.
    Chiou RK, Howe S, Morton JJ, Grune MT, Taylor RJ. Treatment of recurrent vesicourethral anastomotic stricture after radical prostatectomy with endourethroplasty. Urology. 1996;47(3):422–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Castellan MA, Gosalbez R, Labbie A, Monti PR. Clinical applications of the Monti procedure as a continent catheterizable stoma. Urology. 1999;54(1):152–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of UrologyNYU Langone Medical CenterNew YorkUSA
  2. 2.Department of UrologyNew York University Langone Medical CenterNew YorkUSA
  3. 3.Department of UrologyUT Southwestern Medical CenterDallasUSA

Personalised recommendations