title: Single center comparison of anastomotic strictures after radical perineal and radical retropubic prostatectomy.
abstract: OBJECTIVE
  To analyze the incidence and management of anastomotic strictures (ASs) after radical perineal prostatectomy (RPP) and retropubic prostatectomy (RRP) and to identify possible predisposing factors.
  
  
  METHODS
  Between 1997 and 2007, we performed 866 RPP and 2052 RRP for localized prostate cancer. Median follow-up was 52 months (12-136). We analyzed preoperative serum prostate-specific antigen, prostate size, clinical and pathologic tumor stage, neoadjuvant hormone deprivation, previous transurethral resection of the prostate, transfusion requirement, anastomotic insufficiency, and acute urinary retention (AUR) and its subsequent management to identify possible predisposing factors for AS formation.
  
  
  RESULTS
  The rate of AS after RPP and RRP was 3.8% (33/863) and 5.5% (113/2048), respectively (P = .067). In multivariate analysis, RRP was a statistically significant risk factor for AS (P = .0002). On survival analysis, the incidence of AS was lower for RPP as compared with RRP at median follow-up (P = .0229). Primary response to endoscopic AS incision or resection was 94% (31/33) and 72.6% (82/113) after RPP and RRP, respectively. On multivariate logistic regression analysis biopsy Gleason score, previous transurethral resection of the prostate, prostate volume, pathologic tumor stage and grade, transfusion requirement, AUR, and surgical technique were independent risk factors for the development of AS. An AS developed in 45.4% (20/44) and 10.9% (5/46) of the postoperative AUR cases treated with a suprapubic cystostomy tube and a transurethral Foley catheter, respectively (P <.05).
  
  
  CONCLUSIONS
  ASs occur more frequently after RRP in comparison with RPP. Primary endoscopic AS incision or resection are both highly successful. Treating postoperative AUR with a suprapubic cystostomy poses a high risk for AS formation and should be avoided.
authors.affiliation: Department of Urology, Johannes Gutenberg-University Medical School, Mainz, Germany. gillitze@mail.uni-mainz.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Gillitzer
authors.forename: Christian
authors.initials: C
authors.lastname: Thomas
authors.forename: Christoph
authors.initials: C
authors.lastname: Wiesner
authors.forename: Jon
authors.initials: J
authors.lastname: Jones
authors.forename: Folke
authors.initials: F
authors.lastname: Schmidt
authors.forename: Christian
authors.initials: C
authors.lastname: Hampel
authors.forename: Walburgis
authors.initials: W
authors.lastname: Brenner
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Melchior
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000453:epidemiology* / Q000209:etiology*; D001743:Urinary Bladder / Q000601:surgery*