Incidence of bladder neck contracture after robot‐assisted laparoscopic and open radical prostatectomy

Abstract

OBJECTIVE To evaluate the incidence and risk factors for bladder neck contracture (BNC) in men treated with robot-assisted laparoscopic radical prostatectomy (RALP) and open radical prostatectomy (ORP), as BNC is a well-described complication of ORP and may be partially attributable to technique. PATIENTS AND METHODS The University of California San Francisco Urologic Oncology Database was queried for patients undergoing RALP or ORP from 2002 to 2008. Patient demographics, prostate cancer-specific information, surgical data, and follow-up were collected. For each surgical approach, multivariate Cox proportional hazards regression was performed to evaluate associations of demographics and clinical characteristics with BNC. Time to BNC after RP was evaluated using life table and Kaplan–Meier methods. RESULTS From 2002 to 2008, 988 patients underwent RP as primary treatment and had at least 12 months of follow-up. Of these men, 695 underwent ORP and 293 underwent RALP. The mean (SD) age was 59.3 (6.80) years and 91% of men were Caucasian. D’Amico risk groups at diagnosis were low (38%), intermediate (38%), and high (24%). The BNC incidence was 2.2% (22 cases) overall, 1.4% (four) for RALP, and 2.6% (18) for ORP (P = 0.12). Patients with BNC were diagnosed a median (range) of 4.7 (1–15) months after surgery. At 18 months after surgery, the BNC-free rate was 97% for ORP and 99% for RALP (log-rank P = 0.13). The most common presenting complaint was slow stream, followed by urinary retention. In Cox proportional hazards regression analysis, earlier year of surgery, older age at diagnosis and higher PSA level at diagnosis were significantly associated with BNC among ORP patients. In the RALP group, none of the covariates were associated with BNC. CONCLUSIONS The overall incidence of BNC was low in both RALP and ORP groups. Technical factors such as enhanced magnification and a running bladder anastomosis may explain the lower BNC incidence in the RALP group.

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

“…In the contemporary literature, bladder neck contractures are reported in 0 to 7.4% of RALP patients and in 2.6 to 9% of patients after open radical prostatectomy (9,10,12,17,18). The exact cause of bladder neck contracture is not known although several theories exist.…”

New model of urethral catheter in treatment of patients after radical prostatectomy: efficiency and possibilities of implementation into clinical practice

“…Совре-менные достижения в лечении РПЖ позволили мини-мизировать число послеоперационных осложнений, в том числе стриктуры ВУА, тем не менее частота ее развития по-прежнему остается высокой и варьирует от 0,7 до 10,0 % [15]. По мнению разных авторов, в группе больных, перенесших РАРПЭ, частота выяв-ления стриктуры ВУА достигает 28,7 %, в то время как после открытой РПЭ этот показатель несколько выше -29,3 % [16][17][18]. Подчеркнем, что на вероят-ность развития стриктур ВУА могут влиять такие фак-торы, как неадекватное сопоставление тканей слизистой оболочки шейки мочевого пузыря и моче-испускательного канала, недостаточная герметичность анастомоза, длительная ишемия и деваскуляризация шейки мочевого пузыря, анатомическая узость уре-тры, проведение гормональной терапии перед опера-цией, перенесенные ранее трансуретральная резекция предстательной железы и дистанционная лучевая те-рапия, а также опыт хирурга [19][20][21][22].…”

Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis

“…Bladder neck contracture (BNC) is a known complication of RP. Breyer et al [36] reported that the BNC rate was 1.4 % for RALP and 2.6 % for ORP. Webb et al [37] also reported that RALP was superior to ORP in the incidence of BNC.…”