Journal article
Durable Treatment of Refractory Vesicourethral Anastomotic Stenosis via Robotic-assisted Reconstruction: A Trauma and Urologic Reconstructive Network of Surgeons Study
European urology, Vol.81(2), pp.176-183
02/01/2022
DOI: 10.1016/j.eururo.2021.08.013
PMID: 34521553
Abstract
Background: Refractory vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy poses challenges distinct from bladder neck contracture, due to close proximity to the sphincter mechanism. Open reconstruction is technically demanding, risking de novo stress urinary incontinence (SUI) or recurrence. Objective: To demonstrate patency and continence outcomes of robotic-assisted VUAS repair. Design, setting and participants: Patients with VUAS underwent robotic-assisted reconstruction from 2015 to 2020 in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) consortium of institutions. The minimum postoperative follow-up was 3 mo. Surgical procedure: The space of Retzius is dissected and fibrotic tissue at the vesicourethral anastomosis is excised. Reconstruction is performed with either a primary anastomotic or an anterior bladder flap-based technique. Measurements: Patency was defined as either the passage of a 17 French flexible cystoscope or a peak flow on uroflowmetry of >15 ml/s. De novo SUI was defined as either more than one pad per day or need for operative intervention. Results and limitations: A total of 32 patients met the criteria, of whom 16 (50%) had a history of pelvic radiation. Intraoperatively, 15 (47%) patients had obliterative VUAS. The median length of hospital stay was 1 d. At a median follow-up of 12 mo, 24 (75%) patients had patent repairs and 26 (81%) were voiding per urethra. Of five men with 30-d complications, four were resolved conservatively (catheter obstruction and ileus). In eight patients, recurrent stenoses were managed with redo robotic reconstruction (in two), endoscopically (in four), or catheterization (in two). Of 13 patients without preexisting SUI, 11 (85%) remained continent at last follow-up. No patients underwent urinary diversion. Conclusions: Robotic-assisted VUAS reconstruction is a viable and successful management option for refractory anastomotic stenosis following radical prostatectomy. The robotic transabdominal approach demonstrates high patency and continence rates.
Details
- Title: Subtitle
- Durable Treatment of Refractory Vesicourethral Anastomotic Stenosis via Robotic-assisted Reconstruction: A Trauma and Urologic Reconstructive Network of Surgeons Study
- Creators
- Nabeel A. Shakir - New York UniversityNejd F. Alsikafi - UroPartners, Gurnee, IL, USAJulia F. Buesser - UroPartners, Gurnee, IL, USAGregory Amend - Department of Urology; University of California San Francisco; San Francisco, CA USABenjamin N. Breyer - Department of Urology; University of California San Francisco; San Francisco, CA USAJill C. Buckley - University of California, San DiegoBradley A. Erickson - University of IowaJoshua A. Broghammer - University of Kansas Medical CenterWilliam P. Parker - University of Kansas Medical CenterLee C. Zhao - New York University
- Resource Type
- Journal article
- Publication Details
- European urology, Vol.81(2), pp.176-183
- Publisher
- Elsevier
- DOI
- 10.1016/j.eururo.2021.08.013
- PMID
- 34521553
- ISSN
- 0302-2838
- eISSN
- 1873-7560
- Number of pages
- 8
- Language
- English
- Date published
- 02/01/2022
- Academic Unit
- Urology
- Record Identifier
- 9984320061102771
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