Vesicourethral Anastomotic Stenosis Following Radical Prostatectomy: Risk Factors, Natural History, and Treatment Outcomes

• Published in: The Journal of urology Vol. 210; no. 2; pp. 312 - 322
• Main Authors: Britton, Cameron J, Sharma, Vidit, Fadel, Anthony E, Bearrick, Elizabeth, Findlay, Bridget L, Frank, Igor, Tollefson, Matthew K, Karnes, R Jeffrey, Viers, Boyd R
• Format: Journal Article
• Language: English
• Published: United States 01.08.2023
• Subjects: Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Constriction, Pathologic - epidemiology; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Humans; Male; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Prostate - surgery; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - etiology; Prostatic Neoplasms - surgery; Risk Factors; Transurethral Resection of Prostate; Treatment Outcome; Urethra - surgery; Urinary Incontinence - epidemiology; Urinary Incontinence - etiology; Urinary Incontinence - surgery; urethral stricture; prostatectomy; cystoscopy; dilatation; prostatic neoplasms
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1097/JU.0000000000003488

Vesicourethral anastomotic stenosis after radical prostatectomy is a complication with significant adverse quality-of-life implications. Herein, we identify groups at risk for vesicourethral anastomotic stenosis and further characterize the natural history and treatment patterns. Years 1987-2013 of a prospectively maintained radical prostatectomy registry were queried for patients with the diagnosis of vesicourethral anastomotic stenosis, defined as symptomatic and inability to pass a 17F cystoscope. Patients with follow-up less than 1 year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of vesicourethral anastomotic stenosis. Functional outcomes were characterized. Out of 17,904 men, 851 (4.8%) developed vesicourethral anastomotic stenosis at a median of 3.4 months. Multivariable logistic regression identified associations with vesicourethral anastomotic stenosis including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and nonnerve-sparing techniques. Robotic approach (OR 0.39, < .01) and complete nerve sparing (OR 0.63, < .01) were associated with reduced vesicourethral anastomotic stenosis formation. Vesicourethral anastomotic stenosis was independently associated with 1 or more incontinence pads/d at 1 year (OR 1.76, < .001). Of the patients treated for vesicourethral anastomotic stenosis, 82% underwent endoscopic dilation. The 1- and 5-year vesicourethral anastomotic stenosis retreatment rates were 34% and 42%, respectively. Patient-related factors, surgical technique, and perioperative morbidity influence the risk of vesicourethral anastomotic stenosis after radical prostatectomy. Ultimately, vesicourethral anastomotic stenosis is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men, with a high rate of retreatment by 5 years.