ABSTRACT
BACKGROUND:
Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life.
OBJECTIVES:
To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS.
DESIGN AND SETTING:
Retrospective cross-sectional single-center study on data covering January 2009 to December 2019.
METHODS:
Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS.
RESULTS:
Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence.
CONCLUSIONS:
VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.
KEY WORDS (MeSH terms):
Urinary bladder neck obstruction; Prostatectomy; Cicatrix, hypertrophic
AUTHORS’ KEY WORDS:
Proliferative hypertrophic scar; Retropubic radical prostatectomy; Vancouver scar scale; Vesicourethral anastomotic stenosis
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