Robotic Post Radical Prostatectomy bladder neck stenosis

• 21 Feb 2020 12:22:27 PM
• |Reconstructive Urology

Posterior Lower Urinary tract issues should be divided in 2 categories as per etiology :

Comments(2)

• 

  Dr. Anil Takvani

  22 Feb 2020 11:17:30 AM

  Sir, Thank you very much for posting approaches for posterior urethral strictures.

  Can some one highlight on incidence of bladder neck stenosis following radical prostectomy?

  And any difference in incidence with robot assisted radical prostectomy?

  Thanks

• 

  Venugopal P

  24 Feb 2020 09:36:52 AM

  Dear All,

  I even now believe that a stricture of urethra due to whatever cause needs lifelong attention and whatever methods at treatment that we adopt is at best temporary in alleviating the problem. Even a well done urethroplasty, even with experienced hands, produce recurrence in many and need probably repeat surgical interventions. The quoted figures in literature vary with very few studies mentioning long term outcomes. Hence it is apt to say even today that ‘once a stricture always a stricture’. I am sure many in our group may not like this factual statement. If a stricture can be effectively cured by the treatment adopted, then there should be no need for relook and suggesting self catheterisation etc.

  Posterior Urethral Strictures are often more complex and need Expertise to tackle the problem.

  No surgery has ever been described without its inherent complications. But as surgeons, we tend to underplay complications and quite often keep it to ourselves. We harp on our successes. It needs courage to talk on complications.

  In the article mentioned by Sanjay on Bladder Neck Stenosis (Stricture), it is obvious that posterior urethral strictures can occur with most of the treatments that we adopt for Prostatic cancer and even for benign conditions. Cindolo et al (2017) reported that 10% of patients develop bladder neck contracture (BNC) after outlet procedures for benign prostatic hyperplasia. Breyer and Cowan et al (2010) found that Lap RP and RARP have developed vesicourethral anastomotic stenosis (VUAS) in 3%. Browne and Vanni (2017) found that up to one-third of men undergoing pelvic radiation ultimately develop prostatic urethral stenosis. With advent of Focal therapies for P Ca, it is possible that the incidence of such complications could increase.

  Sanjay has provide the flow chart as given by Timothy C Boswell, Boyd R Viers* et al (2020). This could help us to plan the treatment option if and when we encounter such a complication. Sanjay has mentioned that in India, Perineal approach with Inferior Pubectomy could still be the preferred approach. What I would like to know is how feasible it is in a postoperative situation where there could be considerable postop fibrosis. I do not know whether RALP causes less fibrosis than other techniques of RP. No doubt posterior Urethroplasties are done in a milieu of fibrosis.

  It is important for us to discuss on complications associated with surgeries for the many who are less experienced at present but could be leading lights in the future to know.

  I must compliment Sanjay for the write up he has provided.

  With warm regards,

  Venu