Surgical and Functional Outcomes of Bladder Neck Incision for Primary Vesico-Urethral Anastomosis Stricture after Robot-assisted Radical Prostatectomy are Influenced by the Presence of Pre- or Postoperative Radiotherapy.

To report the intermediate- to long-term outcomes of bladder neck incision (BNI) for vesico-urethral anastomosis stricture (VUAS) after robot-assisted radical prostatectomy (RARP) and the influence of pre- or post-RARP radiotherapy on these outcomes.

A retrospective cohort study was performed with patients who underwent BNI for VUAS after RARP in a high-volume prostatectomy centre between 2006 and July 2021. Data was collected from patient charts. The cohort was divided into four groups: VUAS after 1) RARP-only, 2) RARP, but before salvage radiotherapy (SRT) (VUASpreSRT), 3) RARP and after SRT (VUASpostSRT), and 4) primary radiotherapy and salvage RARP (SRARP). The VUAS recurrence rates, the ability to perform functional transurethral micturition and the post-BNI urinary continence rates were reported.

BNI was performed in 90 patients. The median time between first BNI and last follow-up was 32 months (IQR 10-58, range 0-171). The majority of VUAS occurred within 6 months after (S)RARP. In those who underwent BNI, recurrent VUAS was reported in 12%, 57%, 29%, and 50% of patients after RARP-only, VUASpreSRT, VUASpostSRT, and SRARP, respectively. Ultimately, transurethral micturition was possible in 94%, 93%, 71%, and 80%, respectively. Severe urinary-incontinence rates (>1 pads/day) were 6%, 16%, 10%, and 29% for RARP-only, VUASpreSRT, VUASpostSRT, and SRARP patients, respectively.

Primary radiotherapy before RARP and SRT after RARP significantly influenced the success rates of BNI. Those who underwent BNI after SRARP had worse outcomes than patients who underwent RARP only.

Urology. 2022 Mar 19 [Epub ahead of print]

Hans Veerman, André N Vis, Marinus J Hagens, Corinne T Tillier, Ton A Roeleveld, Esther Wit, Tim M van der Sluis, Pim J van Leeuwen, Garry L S Pigot, Jakko A Nieuwenhuijzen, Henk G van der Poel

Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical centers, location VU, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, Amsterdam University Medical centers, location VU, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical centers, location VU, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands., Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, NorthWest Clinics, location Alkmaar, The Netherlands.