Abstract

Objectives

To investigate the predictors of recurrence and of de novo incontinence in patients treated by transurethral incision or resection for vesico-urethral anastomotic stenosis (VUAS) after radical prostatectomy.

Material and methods

All patients undergoing endoscopic treatment for VUAS between March 2009 and October 2016 were identified in our multi-institutional database. Digital chart reviews were performed and patients contacted for follow-up. Recurrence was defined as any need for further instrumentation or surgery, and de-novo-incontinence as patient-reported outcome.

Results

Of 103 patients undergoing endoscopic VUAS treatment, 67 (65%) underwent transurethral resection (TR) and 36 (35%) transurethral incision (TI). TI was performed more frequently as primary treatment compared to TR (58% vs. 37%; p = 0.041). Primary and repeated treatment was performed in 46 (45%) and 57 patients (55%), respectively. Overall, 38 patients (37%) had a history of radiation therapy. There was no difference in time to recurrence for primary vs repeat VUAS treatment, previous vs no radiation, TR compared to TI (all p > 0.08). Regarding treatment success, no difference was found for primary vs. repeat VUAS treatment (50% vs. 37%), previous radiation vs. no radiation (42% vs. 43%), and TR vs. TI (37% vs. 53%; all p ≥ 0.1). Postoperative de novo incontinence was more common after TI vs. TR (31% vs. 12%; p = 0.032), no difference was observed for previous radiation therapy vs. no radiation therapy (18% vs. 18%; p > 0.9) or primary vs. repeat VUAS treatment (22% vs. 16%; p = 0.5).

Conclusion

VUAS recurrence after endoscopic treatment is not predictable. Endoscopic treatment with TI showed a higher risk for de novo incontinence than TR, and previous irradiation and the number of treatments do not influence incontinence.

中文翻译：

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根治性前列腺切除术后膀胱-尿道吻合口狭窄：多机构结果分析，重点关注内窥镜方法、手术顺序和放射治疗的影响

摘要

目标

研究在根治性前列腺切除术后经尿道切开或切除治疗膀胱尿道吻合口狭窄（VUAS）的患者中复发和新发失禁的预测因素。

材料与方法

在我们的多机构数据库中确定了 2009 年 3 月至 2016 年 10 月期间接受 VUAS 内镜治疗的所有患者。进行了数字图表审查，并联系了患者进行随访。复发被定义为任何需要进一步器械或手术的需要，重新失禁被定义为患者报告的结果。

结果

在接受内镜 VUAS 治疗的 103 名患者中，67 名（65%）接受了经尿道切除术（TR）和 36 名（35%）经尿道切开术（TI）。与 TR 相比，TI 作为主要治疗的执行频率更高（58% 对 37%；p  = 0.041）。分别对 46 名 (45%) 和 57 名 (55%) 患者进行了初级和重复治疗。总体而言，38 名患者 (37%) 有放射治疗史。与 TI 相比，初次 VUAS 治疗与重复 VUAS 治疗、既往与无放射治疗、TR 与 TI 相比，复发时间没有差异（所有p  > 0.08）。关于治疗成功率，初次 VUAS 治疗与重复 VUAS 治疗（50% 与 37%）、既往放疗与未放疗（42% 与 43%）以及 TR 与 TI（37% 与 53 %; 所有p ≥ 0.1)。TI 与 TR 后术后新发失禁更常见（31% 与 12%；p  = 0.032），之前放疗与未放疗之间未观察到差异（18% 与 18%；p  > 0.9）或主要与重复 VUAS 治疗（22% 与 16%；p  = 0.5）。

结论

内镜治疗后 VUAS 复发是不可预测的。TI 的内镜治疗显示出比 TR 更高的新发失禁风险，并且先前的放疗和治疗次数不影响失禁。