PD63-04 TRANSPERINEAL PRE-RECTAL APPROACH TO OPEN REPAIR OF VESICOURETHRAL ANASTOMOTIC STENOSIS: OUR INITIAL EXPERIENCE AND RESULTS.

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2018PD63-04 TRANSPERINEAL PRE-RECTAL APPROACH TO OPEN REPAIR OF VESICOURETHRAL ANASTOMOTIC STENOSIS: OUR INITIAL EXPERIENCE AND RESULTS. Alexei Zhivov, Alexei Plekhanov, Alexander Koshmelev, Igor Reva, Oleg Loran, and Dmitry Pushkar Alexei ZhivovAlexei Zhivov More articles by this author , Alexei PlekhanovAlexei Plekhanov More articles by this author , Alexander KoshmelevAlexander Koshmelev More articles by this author , Igor RevaIgor Reva More articles by this author , Oleg LoranOleg Loran More articles by this author , and Dmitry PushkarDmitry Pushkar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2964AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicourethral anastomotic stenosis (VUAS) is the recognized complication of radical prostatectomy occurring in 0,5 – 30% of cases in different series. Treatment objectives are restoration of normal urination and prevention of severe urinary incontinence (UI). After several failed attempts of endoscopic procedures (EP), open reconstruction is indicated. Currently there is no standard procedure for open VUAS repair. Elaborated transperineal approach, described by G. Webster et al. (1983), is the most widely used option. We hypothesized that pre-rectal approach, same as for radical perineal prostatectomy, described by E. Austoni et al. (2005) for posterior urethroplasty may be better procedure for VUAS reconstruction. METHODS From 2009 to 2017 we've operated 20 patients (age 64,1+/-5,7 y.o.) with VUAS. In 7 cases we have used Webster technique and in 13 modified Austoni technique. Follow-up ranged from 6 to 96 months (median 25). Fisher's exact test, logistic regression (LR), t-test, Wilcoxon and chi-square tests were used to evaluate the influence of patients age, surgical approach, amount of previous EPs, diabetes mellitus, cardiovascular diseases, obesity and smoking on the development of failure and UI. RESULTS Total surgical success rate was 14/20 cases (70%). UI developed in all patients, severe in 7/20 (30%) and mild to moderate in 13/20 (70%). Success rate in Webster procedure group was 2/7 (29%), in the Austoni procedure group 12/13 (92%). Severe UI rate was 4/7 (57%) in Webster group and 3/13 (23%) in Austoni group. The only factor having statistically significant influence on failure development was surgical technique (p = 0,007). Increasing number of EPs (Fisher's test p = 0,056, LR full model p=0.04) and obesity (Fisher's test p = 0,079) were close to statistically significant influence on failure and should be reassessed in larger series. The only significantly influencing factor on the development of severe UI was the amount of EPs (p = 0,012), other factors did not. CONCLUSIONS Pre-rectal transperineal approach (Austoni) seems to be better procedure for open surgical management of VUAS than elaborated transperineal approach (Webster) in terms of success rate. Better visualization and closer proximity of VUAS site, exhaustive scars excision, mobilization of the bladder neck and possible preservation of external sphincter mechanism are the advantages. The amount of repeated EPs for VUAS correction should be as low as possible in order to avoid severe UI. These two measures may improve functional results of open VUAS repair. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1215 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alexei Zhivov More articles by this author Alexei Plekhanov More articles by this author Alexander Koshmelev More articles by this author Igor Reva More articles by this author Oleg Loran More articles by this author Dmitry Pushkar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...