Vesicourethral Anastomotic Stenosis Following Radical prostatectomy: Risk Factors, Natural History, and Treatment Outcomes.

Abstract

Vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy (RP) is a complication with significant adverse quality of life implications. Herein, we identify groups at risk for VUAS and further characterize natural history and treatment patterns. Years 1987-2013 of a prospectively maintained RP registry were queried for patients with the diagnosis of VUAS, defined as symptomatic and inability to pass a 17Fr cystoscope. Patients with follow up less than 1-year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of VUAS. Functional outcomes were characterized. Out of 17,904 men, 851 (4.8%) developed VUAS at a median 3.4 months. Multivariable logistic regression identified associations with VUAS including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and non-nerve sparing techniques. Robotic approach (OR 0.39, P < .01) and complete nerve sparing (OR 0.63, P < .01) were associated with reduced VUAS formation. VUAS was independently associated with 1 or more incontinence pads/day at 1 year (OR 1.76, P < .001). Of the patients treated for VUAS, 82% underwent endoscopic dilation. The 1- and 5-year VUAS retreatment rates were 34% and 42%, respectively. Patient related factors, surgical technique, and perioperative morbidity influence the risk of VUAS after RP. Ultimately, VUAS is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men with a high rate of retreatment by 5 years.