Vesicourethral anastomotic stenosis is a well-known late complication after open radical retropubic prostatectomy (RRP) with previously reported incidences of 2.7-15%. There are few reports of the incidence after robot-assisted laparoscopic radical prostatectomy (RALP) compared with RRP.
The aim was to compare the risk of developing symptomatic stenosis after RRP and RALP, and to explore potential risk factors and the influence of stenosis on the risk of urinary incontinence.
Between 2008 and 2011, 4003 men were included in a prospective trial comparing RRP and RALP at 14 Swedish centres. Clinical data and patient questionnaires were collected before, during, and after surgery.
Stenosis was identified by either patients' reports in questionnaires or case report forms. The primary endpoint is reported as unadjusted as well as adjusted relative risks (RRs), calculated with log-binomial regression models. Data on incontinence were analysed by means of a log-binomial regression model, with stenosis as an independent and incontinence as a dependent variable.
Symptomatic stenosis developed in 1.9% of 3706 evaluable men within 24 mo. The risk was 2.2 times higher after RRP than after RALP (RR 2.21, 95% confidence interval [CI] 1.38-3.53). Overall, urinary incontinence was twice as common in patients who had stenosis (RR 2.01, 95% CI 1.43-2.64).
This large prospective study found an overall low rate of vesicourethral anastomotic stenosis after radical prostatectomy, but the rate was significantly lower after robot-assisted prostatectomy. The risk of stenosis seems to be associated with the number of sutures/takes in the anastomosis, but this was statistically significant only in the RALP group.
We investigated the risk of developing vesicourethral anastomotic stenosis after open and robot-assisted radical prostatectomy. We found that the risk was generally lower than previously reported and lower after robot-assisted radical prostatectomy than after radical retropubic prostatectomy. Urinary incontinence was twice as common in patients with stenosis.
European urology focus. 2019 Nov 08 [Epub ahead of print]
Katarina Koss Modig, Rebecka Arnsrud Godtman, Anders Bjartell, Stefan Carlsson, Eva Haglind, Jonas Hugosson, Marianne Månsson, Gunnar Steineck, Thordis Thorsteinsdottir, Stavros Tyritzis, Anna Wallerstedt Lantz, Peter Wiklund, Johan Stranne
Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: ., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Urology, Skåne University Hospital, Malmö, Sweden; Division of Urological Cancers, Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden., Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden., Department of Surgery, Institute of Clinical Sciences, Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Division of Clinical Cancer Epidemiology,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Oncology andPathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden., Research Institute in Emergency Care, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Nursing, University of Iceland, Reykjavik, Iceland., Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Hygeia Hospital, Athens, Greece., Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden; Icahn School of medicine at Mount Sinai Health System, New York City, NY, USA.