Abstract
You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 2011203 PERINEAL-REANASTOMOSIS FOR THE TREATMENT OF RECURRENT ANASTOMOTIC STRICTURES: OUTCOME AND PATIENT SATISFACTION Philip Reiss, Daniel Pfalzgraf, Louis Kluth, Hendrik Isbarn, Oliver Balzer, Wolf-Hartmut Meyer-Moldenhauer, Felix K.-H. Chun, Sascha Ahyai, Oliver Engel, Silke Riechardt, Margit Fisch, and Roland Dahlem Philip ReissPhilip Reiss Hamburg, Germany More articles by this author , Daniel PfalzgrafDaniel Pfalzgraf Hamburg, Germany More articles by this author , Louis KluthLouis Kluth Hamburg, Germany More articles by this author , Hendrik IsbarnHendrik Isbarn Hamburg, Germany More articles by this author , Oliver BalzerOliver Balzer Hamburg, Germany More articles by this author , Wolf-Hartmut Meyer-MoldenhauerWolf-Hartmut Meyer-Moldenhauer Hamburg, Germany More articles by this author , Felix K.-H. ChunFelix K.-H. Chun Hamburg, Germany More articles by this author , Sascha AhyaiSascha Ahyai Hamburg, Germany More articles by this author , Oliver EngelOliver Engel Hamburg, Germany More articles by this author , Silke RiechardtSilke Riechardt Hamburg, Germany More articles by this author , Margit FischMargit Fisch Hamburg, Germany More articles by this author , and Roland DahlemRoland Dahlem Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.274AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent anastomotic strictures after radical prostatectomy are a rare but troublesome complication. In these cases, open surgery can be the last therapeutic option before urinary diversion. Unlike the retropubic approach for bulbo-bladderneck reanastomosis, the perineal approach offers the possibility to perform surgery in virgin tissue after radical retropubic prostatectomy (RRP). The study was conducted to assess the outcome, satisfaction and the improvement of quality of life for perineal reanastomosis in patients with highly recurrent anastomotic stricture. METHODS Comprehensive retrospective analysis by pts chart review and non-validated standardized questionnaire of 15 pts treated by perineal reanastomosis for highly recurrent anastomotic stricture after RRP in 2007–2010. Previous surgeries, recurrence rate, complications, incontinence, erectile function, satisfaction and quality of life were assessed. The perineal approach was performed by half-moon incision and dissection to the urethra under rectal-digital palpation. Tension-free anastomosis was achieved after complete excision of the scar and wide mobilisation of urethra and bladder. RESULTS Mean age was 65 yrs. (range 51–75), mean follow up was 13.4 months (6–35). All pts. had had multiple previous (trans-) urethral surgeries (range 2–17). Mean length of urethral strictures was 3,1 cm (range 1–5cm). Success rate was 93.3% (1 recurrence, successfully treated by cold knife incision). As post-op complications, 2 urinary tract infections occurred. 66% of patients were incontinent pre- and postoperative. Due to transsphincteric mobilisation of the urethra, an aggravation of incontinence was found in 60%. In all cases with incontinence, the implantation of artificial urinary sphincter (AUS) with a distal double cuff was planned and has yet been performed in 10 cases. 93% of pts. report of strong, 7% of moderate urinary stream, pts. satisfaction was very high in 73.3%, high in 20%, 6.7% were undecided. Quality of life improved in 86.7%, 13.3% report no change. CONCLUSIONS The perineal approach for the repair of anastomotic strictures represents a successful and safe method in cases with multiple previous surgeries and improves quality of life with good satisfaction rates. The great advantage is the surgery in virginal tissue. The incontinence is easily treated by AUS implantation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e84 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philip Reiss Hamburg, Germany More articles by this author Daniel Pfalzgraf Hamburg, Germany More articles by this author Louis Kluth Hamburg, Germany More articles by this author Hendrik Isbarn Hamburg, Germany More articles by this author Oliver Balzer Hamburg, Germany More articles by this author Wolf-Hartmut Meyer-Moldenhauer Hamburg, Germany More articles by this author Felix K.-H. Chun Hamburg, Germany More articles by this author Sascha Ahyai Hamburg, Germany More articles by this author Oliver Engel Hamburg, Germany More articles by this author Silke Riechardt Hamburg, Germany More articles by this author Margit Fisch Hamburg, Germany More articles by this author Roland Dahlem Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...
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