MP9-13 NEW INSIGHT INTO POST-ROBOTIC PROSTATECTOMY BLADDER NECK CONTRACTURE: THE ROLE OF EXTRUDED HEMOLOCK CLIPS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2014MP9-13 NEW INSIGHT INTO POST-ROBOTIC PROSTATECTOMY BLADDER NECK CONTRACTURE: THE ROLE OF EXTRUDED HEMOLOCK CLIPS Alla Hamada and Sanjay Razdan Alla HamadaAlla Hamada More articles by this author and Sanjay RazdanSanjay Razdan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post radical prostatectomy bladder neck contracture (BNC) is moderate to severe scarring process involving urethrovesical (U-V) anastomosis resulting in bladder outlet obstruction. Its incidence has been notably reduced with use of robotic assisted laparoscopic prostatectomy (RALP). Weck clips have been used to ligate lateral vascular pedicles and aid in dissection of neurovascular bundles. OBJECTIVE To examine BNC developed after RALP in terms of prevalence, clinical presentation pattern, cystoscopic findings, possible associated risk factors and response to treatment. METHODS After obtaining IRB approval, the retrospective data of 1718 men with prostate cancer who underwent RALP by a high volume surgeon in the period between May, 2004 and June, 2012 were prospectively analyzed to investigate prevalence and risk factors of BNC. The recorded data included clinical, laboratory perioperative, cystoscopic findings (presence of stricture, extruded Weck Hemolock clips and associated bladder stone), number of contemplated laser bladder neck incision (BNI) procedures and rate of recurrence. In all patients, urethrovesical (U-V) anastomosis was performed using Van-Velthoven technique, utilizing running double-armed 3-0 Monocryl suture. RESULTS Prevalence of post-RALP BNC after a median follow-up period of 24 months, was 43/1718 (2.5%). BNC developed after a mean and median period of 9.9 and 6 months, respectively. Within patients with BNC, two categories were identified based on cystoscopic findings: a) 23 patients (53%) had pure U-V anastomotic stricture related BNC (SRBNC) and b) 20 patients (46.5%) had stricture-Weck clip related BNC (SCRBNC), in which single or multiple Hemolock Weck clips were extruded into the U-V anastomotic region resulting into anastomotic stricture. By comparing both groups, no differences were seen in the analyzed parameters. After undergoing laser BNI and removal of extruded clips, recurrence rates of BNC was higher in the SCRBNC (60%) than in SRBNC group (26%) (p=0.025). Patients with SCRBNC required at least 2.2 procedure per patient vs. 1.3 laser BNI procedure in the SRBNC group (P=0.015). CONCLUSIONS Extruded Hemolock Weck clips into vesico-urethral anastomosis in patients who underwent RALP, constitute significant predisposing factor for nearly half of cases of bladder neck contracture and is responsible for its recurrence. Use of biodegradable clips are encouraged to minimize BNC. Table 1. Shows the preoperative, operative and postoperative parameters of the two categories of BNC. Parameter Pure Stricture Clip Related Stricture P value Patients 23 (53.5%) 20 (46.5%) - Age / years 63.3 61.4 0.46 PSA ng/ml 7.5 8.1 0.7 Gleason score G 3+3=6: 15 (65.2%) 10 (50%) G 3+4=7 or 4+3=7: 8(34.8%) 7 (35%) 0.3 G 4+4=8:0 (0%) 2(10%) G ≥ 4+5=9: 0(0%) 1(5%) Prostate volume /g 42.4 47.9 0.3 Operative time/minute 79.8 77.5 0.2 Prolonged urine leak (>150cc/24hour) 3 1 0.6 EBL/ml 102 115 0.8 Time of presentation/months 8 11.4 0.25 Clinical presentation Retention 5 (21.7%) 2 (10%) LUTS 17 (73.9%) 15(75%) Infection 0 (0) 1(5%) 0.5 Hematuria 0 (0) 1(5%) Recto-urethral Fistual 1(4.3%) 1(5%) Rate of continence after BNI 22/23 (95.6%) 19/20 (95%) 0.9 Associated stone 5 (21.7%) 3 (15%) 0.6 Average and range of number of therapeutic BNI 1.3 (1-3) 2.2 (1-6) 0.015 Proportion of men with recurrence after BNI 6 (26%) 12 (60%) 0.025 Average Follow up/ months 30.4 27.5 0.7 Post-op BCR 0 (0) 2 (10) 0.2 Loco-regional disease 2(8.7%) 4(20%) 0.4 BNI: Bladder neck incision, BCR: Biochemical recurrence, G: Gleason, LUTS: Lower urinary tract symptoms, EBL: Estimated blood loss © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e126-e127 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alla Hamada More articles by this author Sanjay Razdan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...