Introduction and Objectives
Identification of parameters associated with an increased risk of the vesicourethral anastomosis stricture formation after the radical prostatectomy (RP).
Material and Methods
A total of 651 patients underwent RP from January 2000 to December 2008. Patients with missing data about the follow-up were excluded from the analysis (n = 42). In addition to standard parameters, specimen weight, margin status, operating time, intraoperative blood loss, technique of bladder neck reconstruction, time to catheter removal, surgical complications and postoperative radiotherapy were registered. The freedom from the anastomotic stricture formation was calculated using the Kaplan-Meier method, multivariate analysis was performed by using the stepwise regression method.
Mean age was 62 years (40–79), mean level of the prostate specific antigen was 10.25 ng/ml (0.59–50.00 ng/ml). As locally advanced were identified 26.76% of specimen, median weight was 49 g (17–203 g). Median operating time was 135 minutes (44–540), mean blood loss 1395 ml and median period of catheterization was 14 days (6–42). Surgical complication occurred in 68 (11.17%) cases. Adjuvant or salvage radiotherapy was indicated in 80 (13.14%) patients. A total of 103 (16.91%) men underwent an endoscopic procedure due to the anastomotic stricture formation, 27 (4.43%) patients repeatedly. Perioperative blood loss (p = 0.034), time to catheter removal (p = 0.001), surgical complication (p < 0.0001) and postoperative radiotherapy (p = 0.0091) were found to be statistically significant in prediction of the anastomotic stricture formation.
Neither any of the preoperative and histological parameters nor surgical technique increased a risk of the vesicourethral anastomosis stricture after RP. Patients at greatest risk for a subsequent endoscopic procedure were those with both perioperative blood loss greater than 1700 ml and surgical complication.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.