BERKELEY, CA (UroToday.com) - Although there is strong evidence to suggest that salvage prostatectomy or cryotherapy may cure a subset of patients with recurrent prostate cancer after radiation therapy these aggressive therapies cause substantial morbidity. The main long-term complication is urinary incontinence which is reported to occur in 45-80% of patients. This incontinence is often severe and refractory to treatment. Previous reports on salvage prostatectomy with bladder neck closure and continent catherizable stomas were troubled with persistent urgency, low capacities, and the need for frequent catherizations. Because of this, the addition of bladder augmentation to this procedure was entertained.

A recent manuscript by E. De, O. L. Westney and colleagues from Albany Medical Center and M. D. Anderson Cancer Center in Houston reports on a series of patients with recurrent prostate cancer after radiation therapy that underwent salvage prostatectomy, bladder neck closure, bladder augmentation, and creation of catherizable stomas. The mean time to surgery after radiation was 61 months. Mean patient age at surgery was 59.5 years. The paper is published in the June 2007 issue of the Journal of Urology.

Eleven patients underwent the above procedure with either catherizable appendicovesicostomy or Monti ileovesicostomy over a 2.5 year period. Self-reported outcome measures included patient questionnaires and the validated Incontinence Symptom Index. Mean follow-up was 32 months.

Analysis of the results showed that the physician noted that 8 of the 11 patients (73%) were dry. Nine of the 11 patients returned the questionnaire. Only 2 of these (22%) reported requiring pads for incontinence. Forty-four percent reported no leakage and only 3 (33%) reported leakage more frequently than once weekly. Three of the 11 (27%) required stomal revision at an average of 24 months, of whom 2 still reported difficult catherization. The mean catherization interval was 3.75 hours versus 2 to 6 hours in the previous series without the bladder augmentation. Seven of the 9 patients (77%) reported that they would repeat the procedure again. The authors report that 10 patients who underwent an attempt and salvage prostatectomy and urethral anastomosis during this time and this group had a 50% incontinence rate and a 40% bladder neck contracture rate.

Of the 11 patients, 3 progressed to metastatic disease, one of whom died. An additional 2 patients had biochemical recurrence that was responsive to hormonal therapy. The editorial comment by Victor Netti suggested that pre-operative urodynamic studies may help determine which patients require the added step of augmentation while undergoing this aggressive surgical management for recurrent prostate cancer after radiation therapy.

De E, Pisters LL, Pettaway CA, Scott S, Westney OL

J Urol. 177(6): 2200-4, June 2007
doi:10.1016/j.juro.2007.01.151

UroToday.com Urologic Trauma & Reconstruction Section

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

Please log-in or register in order to submit comments.

Powered by AkoComment!