Salvage prostatectomy with continent catheterizable urinary reconstruction: a novel approach to recurrent prostate cancer after radiation therapy.
OBJECTIVE
Salvage prostatectomy after full dose radiation therapy is associated with a high risk of urinary incontinence. We evaluated the complications of salvage prostatectomy with continent catheterizable reconstruction and its impact on urinary incontinence.


METHODS
Between August 1995 and February 1999, 13 patients with biopsy proved, locally recurrent prostate cancer after radiation therapy underwent salvage prostatectomy with complete bladder neck closure and reconstruction with an appendicovesicostomy to the native bladder in 9 and ileovesicostomy in 4.


RESULTS
There were no intraoperative complications. Four patients had serious complications necessitating reoperation, including a vesicourethral fistula requiring delayed cystectomy, wound dehiscence with disruption of the appendicovesical anastomosis, leakage from the small bowel anastomosis that resulted in sepsis and death, and stomal stenosis requiring delayed stomal revision in 1 each. Of 12 patients 2 (17%) used pads for incontinence, while 10 were dry during the day and night with a catheterization interval of 2 to 6 hours.


CONCLUSIONS
Salvage prostatectomy with continent catheterizable reconstruction is a technically challenging operation with the potential for serious complications. The postoperative continence rate is excellent and appears superior to those in the literature for salvage prostatectomy and vesicourethral anastomosis.
Pisters
L L
LL
Departments of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
English
S F
SF
Scott
S M
SM
Westney
O L
OL
Dinney
C P
CP
McGuire
E J
EJ
D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D019651:Plastic Surgery Procedures; D016879:Salvage Therapy; D016896:Treatment Outcome; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000209:etiology; D016476:Urinary Reservoirs, Continent