Bladder neck strictures after radical retropubic prostatectomy: still an unsolved problem

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Abstract
Objective: To investigate the factors responsible for anastomotic strictures of the bladder neck after radical retropubic prostatectomy. Patients and methods: Of 239 consecutive patients who underwent radical retropubic prostatectomy between 1987 and 1996, 36 (15%) developed anastomotic strictures after surgery. The influence of tumour stage, previous prostatic surgery, urinary extravasation and postoperative bacteriuria were assessed. Results: In 21 patients (58%), the bladder neck stricture occurred within 3 months of surgery, in 11 (30%) at 4–12 months after surgery and in four (11%) more than 12 months after surgery; three of these also had local recurrence. Advanced tumour stage and positive margins did not correlate with a higher stricture rate, nor was there a significant difference in stricture rates with three or four anastomotic sutures. However, extravasation at the time of catheter removal (16 of 36 patients (44%) with vs 34 of 183 patients without (19%) stricture, bacteriuria of >10 6 c.f.u./mL at the time of catheter removal (stricture group 21 of 36 patients (58%) stricture with vs 71 of 203 (35%) without) and previous prostatic surgery (TURP or open surgery, stricture in 28% of those previously operated vs 13% with no previous surgery) were significant risk factors. Conclusion: There are three risk factors for anastomotic stricture after radical prostatectomy; previous operations on the prostate, extravasation and asymptomatic bacteriuria.

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