Razi Journal of Medical Sciences

Background: Vesicourethral anastomotic stricture (VUAS) is a relatively common complication after Radical Retropubic Prostatectomy (RRP). We reported our experience in treatment of VUAS especially with transurethral resection of fibrosis.

Methods: In a multicentric retrospective cross-sectional study conducted between March 2006 and August 2011, 683 (RRPs) performed by two uro-oncologists, were studied. Patients with VUAS were included in the study based on subjective urinary symptoms and direct cystourethroscopy. VUAS was managed by Urethral Dilatation (UD), Transurethral Incision of Stricture (TUI), Transurethral Resection of scar (TUR) and open reconstruction .Type of treatment and its outcome were recorded and analyzed. Data analysis was performed by SPSS version 18.

Results: Of the 683(RRPs), VUAS Occurred in 58(8.9%) patients. Mean time interval between Foley catheter removal and diagnosis of VUAS was 3.9 months, and mean time of follow up was 36.8 months. Twenty-five patients (43.1 %) with urethral dilatation did not require further treatment .Eighteen patients (31.03%) improved with use of transurethral incision of stricture with or without urethral dilatation. TUR of fibrosis had a good response in 14 (24.13%) who had not responded to UD or TUI. One patient, who did not responded to multiple previous procedures, underwent open reconstruction. The patient was became incontinent after surgery. Following endoscopic treatment, incontinence was not observed in any patients.

Conclusions: Although VUAS is a bothersome complication after RRP it responds to usual endoscopic treatments .In our experience TUR of fibrosis can be performed safely without increased risk of incontinence.