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Extraperitoneal robot-assisted vesicourethral reconstruction to manage anastomotic stricture following radical prostatectomy
- Source :
- European Urology Supplements. 18:e2708
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Objective To demonstrate the feasibility of robot-assisted vesicourethral reconstruction. Vesicourethral anastomotic stricture following radical prostatectomy is a real challenge for reconstructive surgery when facing several endoscopic management failures. Material and Methods This is a case series of robot-assisted vesicourethral reconstruction for anastomotic stricture failing endoscopic management. The procedure was performed with an extraperitoneal approach. The fibrotic anastomotic region was resected and a new vesicourethral running suture was performed with well-vascularized tissue. Bladder catheter was removed after 7 days. Results Six procedures were performed from April 2013 to May 2018 at our department. One patient had a robot-assisted radical prostatectomy at our department; the 5 others were referred from other institutions after receiving open prostatectomies. Three patients had salvage radiation therapy before reconstruction. Mean age was of 73.8 years (68-82). There was no peroperative complication. Mean operative time was of 108 minutes (60-180)], with a mean estimated blood loss of 130 mL (50-300). After surgery, 3 patients presented recurrences managed endoscopically without recurrence after 3, 5, and 11 months. Three patients presented incontinence treated with artificial sphincter implantation. One patient had no residual symptom after 5 years of follow-up. Conclusions Robot-assisted vesicourethral reconstruction is a safe procedure. It is an option to consider when facing recurring anastomotic stricture following radical prostatectomy. It is an alternative to the perineal approach and an option before urinary diversion. Patients should be informed of the risks of incontinence and recurrence before surgery especially if they had radiation therapy.
- Subjects :
- Male
Reconstructive surgery
medicine.medical_specialty
medicine.medical_treatment
Urology
Urinary Bladder
030232 urology & nephrology
Constriction, Pathologic
Anastomosis
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Suture (anatomy)
Robotic Surgical Procedures
Urethra
Medicine
Humans
Aged
Retrospective Studies
Aged, 80 and over
Prostatectomy
business.industry
Urinary diversion
Anastomosis, Surgical
Retrospective cohort study
Surgery
Radiation therapy
030220 oncology & carcinogenesis
Feasibility Studies
Peritoneum
business
Complication
Subjects
Details
- ISSN :
- 15699056
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- European Urology Supplements
- Accession number :
- edsair.doi.dedup.....4d5a061f52737603f2bffe31564b85f9