Retrospective Analysis of Vesicourethral‐Anastomosis Stricture/Urethral Stricture After Robotic‐Assisted Laparoscopic Radical Prostatectomy With and Without Radiotherapy

摘要

BACKGROUND AND OBJECTIVE: Vesicourethral anastomotic stenosis and/or urethral stenosis (VUAS/US) is a complication of robotic-assisted radical prostatectomy (RARP) for prostate cancer. We aimed to evaluate the incidence of VUAS/US after RARP and to identify potential risk factors. MATERIALS AND METHODS: We performed a retrospective assessment of clinical records of patients with RARP as primary prostate cancer treatment (January 2011-December 2018) and investigated associations between VUAS/US formation and radiotherapy, pT-stage, tumor margins, Gleason score, nerve-sparing, and postoperative duration of bladder catheterization. Statistical analysis was performed via uni- and multivariable cox regression; risk estimation was done with the Kaplan-Meier method and log-rank test. RESULTS AND LIMITATIONS: 809 patients were included in the study. Median clinical follow-up was 61.0 months (IQR 50.0-75.0) and 175 (22%) patients received radiotherapy. VUAS and US were recorded in 19 (2.3%) and 10 (1.2%) patients, respectively. Whereas in univariable analysis radiotherapy, pT-stage ≥ pT3a, higher Gleason score, positive tumor margins, nerve-sparing, and prolonged duration of bladder catheterization were significant risk factors, in a multivariable analysis only radiotherapy (p = 0.003) and prolonged duration of bladder catheterization (p = 0.0309) proved to be independently predictive. Estimated 5-year risk of VUAS/US formation was lower without than with radiotherapy (2.1% [95% CI: 0.9-3.3] vs. 7.3% [95% CI: 3.4-11]) and with normal compared to prolonged bladder catheterization (2.6% [95% CI: 1.4-3.8] vs. 9.9% [95% CI: 2.3-18]). Retrospectivity and the limited number of events were our major limitations. CONCLUSIONS AND CLINICAL IMPLICATIONS: Low incidence of VUAS/US in RARP. Patients undergoing radiotherapy or requiring prolonged catheterization should be explicitly informed about the risk of VUAS/US and about symptoms. Also, physicians must be aware.