Anastomotic Strictures Following Radical Prostatectomy: Risk Factors and Management

Surya, Babu V.; Provet, John; Johanson, Karl-Eric; Brown, Jordan

doi:10.1016/s0022-5347(17)40082-6

Cited by 234 publications

(163 citation statements)

References 16 publications

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“…22 The reported rate of bladder neck contracture after RP ranges from 3 to 11.5%. 10,19,23 The present study assumes a rate of 9% and that transurethral resection of the bladder neck will be performed in one third of these men. The remaining men will be dilated with filiform and followers in the urologist's office an average of 1.7 times and then perform self-catherization for an additional 6 months.…”

Section: Costs Of Complicationsmentioning

confidence: 99%

A quantitative analysis of the costs and benefits of prostate cancer screening

Benoit

Grönberg

Naslund

2001

Prostate Cancer Prostatic Dis

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The present study attempts to quantitate in an economically and clinically meaningful manner the cost and cost-effectiveness of prostate cancer screening and subsequent treatment, including complications from that treatment. Outcome data from large prostate cancer screening trials using prostate specific antigen (PSA) and digital rectal examination (DRE) and PSA alone were used to construct the screening model. The benefit of screening is expressed in years of life saved by screening, which is calculated by comparing the survival rate of men with prostate cancer to the survival rate of men in the general population. The cost of screening, treatment, and complications were estimated using the Medicare data base and published reports on the cost, morbidity and mortality for radical prostatectomy. The cost per year of life saved by prostate cancer screening with PSA and DRE was $2339 -3005 for men aged 50 -59, $3905 -5070 for men aged 60 -69, and $3574 -4627 overall for men aged 50 -69. The cost per year of life saved by prostate cancer screening with PSA alone for men aged 50 -70 was $3822 -4956. A sensitivity analysis demonstrates that the cost per year of life saved by prostate cancer screening will not change substantially even if the assumptions in this model have been underestimated or overestimated by 100%. This study quantifies only those parameters which can be reliably compared in concrete terms such as dollars, treatment impact on survival, published complication rates and published treatment costs. Using this type of analysis, prostate cancer screening appears to be a cost-effective intervention. However, the issue of whether prostate cancer screening is cost-effective will be decided definitively only when randomized, controlled trials are available to quantify the costs and benefits of prostate cancer screening. Prostate Cancer and Prostatic Diseases (2001) 4, 138-145.

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Section: Costs Of Complicationsmentioning

confidence: 99%

A quantitative analysis of the costs and benefits of prostate cancer screening

Benoit

Grönberg

Naslund

2001

Prostate Cancer Prostatic Dis

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“…Surya et al have demonstrated that the risk factors for anastomotic strictures were excessive blood loss, extravasation of urine at the anastomotic site and a prior transurethral prostatic operation. 19 Therefore, precise anastomosis can prevent the extravasation of urine, followed by preserving strictures of the vesicourethral anastomosis.…”

Section: Tablementioning

confidence: 99%

Outcome of precise vesicourethral anastomosis following retropubic radical prostatectomy using a Foley catheter

et al. 1999

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Purpose: In order to evaluate precise anastomosis using a Foley catheter, complications following radical retropubic prostatectomy were examined. Methods: Twenty-one patients underwent radical retropubic prostatectomy. Precise vesicourethral anastomosis was performed, visualizing the urethral stump by raising up the urogenital diaphragm using a Foley catheter. Complications, such as prolonged urinary extravasation and temporary urinary retention, were checked when the catheter was removed. Incontinence was evaluated both within 6 weeks and more than 6 weeks after operation. Anastomotic and urethral strictures were also checked during follow up. Results:The follow-up period ranged from 4 to 47 months (mean (± SD) 22.0 ± 12.1 months). Eighteen of 21 patients (85.7%) achieved continence after the operation. However, two patients still had stress incontinence and one patient had mild incontinence. Neither prolonged urinary extravasation nor temporally urinary retention were observed. Anastomotic and urethral stricture were not experienced during follow up. Conclusions: Precise anastomosis using a Foley catheter is technically easy and useful, even for relatively inexperienced urologists, to perform. Patients can often achieve continence following this procedure.

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“…Technical factors postulated to effect BNC rates include: absence of mucosal eversion, poor vesico-urethral apposition, urinary extravasation, excessive narrowing of VUA and ischemia to the bladder neck or membranous urethra (18)(19)(20)(21)(22). Many groups have postulated that excess suture placement may increase the risk of tissue ischemia to the VUA and thus predispose to VUA (23).…”

Section: Introductionmentioning

confidence: 99%

Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model

Perera

Divakaran

Roberts

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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Cite this article as: Marlon Perera, Pranav Divakaran, Matthew Roberts and Eric Chung, Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model, Journal of the Mechanical Behavior of Biomedical Materials, http://dx.doi.org/10.1016Materials, http://dx.doi.org/10. /j.jmbbm.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. MethodsMale porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied util failure of the catheter balloon or the model VUA. Model failure was defined as either 'VUA rupture', 'Catheter passage through VUA' or 'catheter failure'. ResultsTwenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with ovalballoon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002). ConclusionsDuring prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.3

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Anastomotic Strictures Following Radical Prostatectomy: Risk Factors and Management

Cited by 234 publications

References 16 publications

A quantitative analysis of the costs and benefits of prostate cancer screening

A quantitative analysis of the costs and benefits of prostate cancer screening

Outcome of precise vesicourethral anastomosis following retropubic radical prostatectomy using a Foley catheter

Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model

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