The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5-8% of patients after radical prostatectomy.
Usually the clinical symptoms include an irritative and obstructive component similar to benign prostatic hyperplasia. In rare cases, patients suffer from partial or complete stress incontinence as a result of the anastomotic stricture.
The diagnostic workup is similar to the procedure for urethral strictures. In addition to uroflowmetry, a cystourethrogram (CUG) or, if necessary, a micturating cystourethrogram (MCU) can be performed. A urethrocystoscopy can be performed to ensure the diagnosis.
In most cases, endoscopic procedures were performed for treatment. Beside a transurethral dilation of the stricture or the Sachse urethrotomy, the most common procedure is transurethral resection to treat the stricture. However, all procedures are associated with a high recurrence rate. In recurrent strictures, open surgical procedures, usually a perineal reanastomosis, should performed early.
Endourological procedures like transurethral resection are a good treatment option, but due to the high recurrence rates, open surgical procedures should be discussed and if necessary should be performed early.
Der Urologe. Ausg. A. 2017 Dec 05 [Epub ahead of print]
V Beck, M Apfelbeck, M Chaloupka, A Kretschmer, F Strittmatter, S Tritschler
Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland. ., Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.