Operative Korrekturmöglichkeiten der Anastomosenstriktur nach radikaler Prostatektomie

Abstract

Anastomotic strictures following radical prostatectomy for prostate cancer are reported in about 1-8% of all patients. Endourologic management usually does not result in very high cure rates but is associated with very high rates of recurrences. There is no standard management of these postoperative long-term complications and quite often the patient ends up having a transurethral or suprapubic catheter as a simple long-term solution. Twenty-four patients with recurrent anastomotic strictures and a mean of 3.5 (2-9) previous transurethral surgical interventions were operated between 2004 and 2011. All patients underwent perineal bladder neck closure and a continent vesicostomy with either an appendiceal or an ileal stoma implanted in the bladder. The mean OR time was 125 (100-195) min, and the mean time of hospitalisation was 12.5 (9-27) days. There were no significant intra- or perioperative complications. Three patients developed a significant urinary tract infection, two patients had to be treated for the development of a paralytic ileus and one patient needed to undergo revision surgery for a urethral fistula. After a mean follow-up of 37 (10-78) months, two patients developed a stomal stenosis which was corrected surgically. Based on our experience, bladder neck closure and continent vesicostomy represent a valuable therapeutic option in the management of recurrent anastomotic strictures following radical prostatectomy.