The impact of urinary drainage on the development of anastomotic stricture after radical retropubic prostatectomy

Abstract

Anastomotic stricture (AS) is a well-described complication of radical retropubic prostatectomy (RRP) despite all the refinements in surgical technique. We aimed to define and discuss the role of postoperative urinary drainage on AS development. A total of 136 patients with localized prostate carcinoma underwent RRP. In all patients, urethral catheter was removed 3 weeks after RRP without a cystogram. We documented duration of drainage (<3 days, n=86; 3-5 days, n=36; and >5 days, n=14), volume of drainage (<300 ml, n=78; 300-500 ml, n=27; and >500 ml, n=31), and mean volume of drainage per day (<100 ml, n=85 and >100 ml, n=51), continence status, and clinical and histopathological characteristics of patients as risk factors related with AS. AS was diagnosed in 28.6% of patients. The rate was found to be 35.9%, 41%, and 23.1%, consistent with duration, and 38.4%, 15.4%, and 46.2% according to volume of drainage, respectively (P=0.0001). AS occurred in 43.6% and 56.4% of patients concerning mean volume of drainage per day, respectively (P=0.007). Analysis showed that AS was significantly associated with duration (>3 days), total volume (>500 ml), and the mean volume (>100 ml) of urinary drainage among the variables. The rates of urinary incontinence were 30.7% in patients with AS and 6.2% in patients without AS. Time and the amount of urinary drainage were significantly associated with stricture formation following RRP that might be caused by partial disruption of the anastomosis.