A stricture may develop in the vesicourethral anastomosis following radical retropubic prostatectomy. Its occurrence has declined following introduction of improved surgical techniques and robotic procedures.
Patient selection: radical postprostatectomy
Site of the stricture: anastomosis of urethra to the bladder
Symptoms:
(1) urinary frequency
(2) urgency
(3) reduced urine flow (poor urine stream)
(4) urinary retention
(5) high pressure within the bladder
Risk factors:
(1) hematoma
(2) surgical technique
(3) postoperative urine leakage
(4) duration of catheterization
(5) obesity (increased body mass index)
(6) older age
(7) smoking
(8) renal insufficiency
(9) multiple comorbid conditions
(10) intraoperative blood loss > 1,000 mL
Interventions may include:
(1) urethral stent
(2) urethral dilatation
(3) transurethral incision of anastomosis stenosis (TUIAS)
(4) laser urethrotomy
(5) open reconstruction
Risk factors for post-intervention incontinence:
(1) multiple interventions (previous treatment failures)
(2) interventions other than minimally invasive procedures
