Treatment of recurrent vesicourethral anastomotic stricture after radical prostatectomy using plasma-button vaporization

Abstract

Objective. The aim of this study was to evaluate the efficiency of plasma-button vaporization (PBV) in the treatment of recurrent vesicourethral anastomotic stricture (VUAS) following retropubic radical prostatectomy (RRP). Materials and methods. A total of 28 patients (28/138, 20.2%) who had been diagnosed with recurrent VUAS after undergoing RRP to treat localized prostate cancer between January 2008 and January 2014 were treated using PBV. The anastomosis site was vaporized from all quadrants using a PBV electrode. The preoperative and postoperative serum prostate-specific antigen, prostate size, body mass index, pathological tumour stage and previous transurethral resection of the prostate were recorded. Results. All patients had localized prostate cancer (stage ≤ PT3a), and all RRP operations were performed by the same surgeon in a single centre. The mean age was 65.2 ± 7.34 years (range 51–73 years). All patients had undergone previous attempts to open the bladder neck: 21 patients (75%) by dilatation and seven (25%) by internal urethrotomy. The procedure was performed once in 23 patients and twice in five patients. After a mean follow-up of 24 months (range 6–66 months), 25 patients (89.2%) had a well-healed and widely patent bladder neck. Conclusions. The PBV technique proved to be efficient and successful in the treatment of recurrent anastomotic stenosis developing after RRP in terms of both short- and long-term outcomes. The removal of fibrotic tissue with vaporization and avoiding cauterization due to minimal haemorrhage were considered advantageous with regard to recurrence.

Key Words:

• Anastomotic stenosis
• plasma-button vaporization
• retropubic radical prostatectomy
• treatment
• vesicourethral anastomotic stricture

Declaration of interest: The author declares that he has no competing interests. No financial support was received.