title: Open retropubic reanastomosis for highly recurrent and complex bladder neck stenosis.
abstract: OBJECTIVE
  We assessed the success rate of open reanastomosis for highly recurrent bladder neck stenosis resistant to transurethral treatment. Due to the paucity of available data the success rate of this procedure is not well defined, although it can be a last treatment option before urinary diversion.
  
  
  METHODS
  A total of 158 patients were treated for bladder neck stenosis in 1998 to 2007, of whom 20 underwent open reanastomosis for highly recurrent or complex bladder neck stenosis after radical prostatectomy and were seen for followup 3 months postoperatively. They received a standardized questionnaire at the time of data acquisition in this retrospective analysis.
  
  
  RESULTS
  The 20 patients underwent a mean of 3.7 previous surgeries. Median followup was 59.2 months. Stenosis recurred after reanastomosis in 8 patients (40%) while the remaining 60% were recurrence free. Seven recurrences were successfully treated endoscopically, resulting in an overall combined 95% success rate. Urinary diversion was performed in 1 patient with another recurrence after reanastomosis and transurethral resection. Four patients (31%) had new onset incontinence and 13 were completely incontinent, of whom 9 were successfully treated with artificial urinary sphincter implantation. In another patient artificial urinary sphincter implantation is scheduled and 3 elected no further treatment.
  
  
  CONCLUSIONS
  Open reanastomosis for recurrent bladder neck stenosis is a good therapeutic option in cases of endoscopic treatment failure. The initial success rate after reanastomosis was 60%, which increased to 95% after secondary treatment. There was a relatively high risk of new onset incontinence after reconstructive surgery but this was successfully treated with artificial urinary sphincter implantation in most patients.
authors.affiliation: Departments of Urology, University Hospital Hamburg-Eppendorf and Asklepios Clinic Hamburg-Harburg, WHMM, Hamburg, Germany. dp.pfalzgraf@googlemail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Pfalzgraf
authors.forename: Maike
authors.initials: M
authors.lastname: Beuke
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Christoph Philip
authors.initials: CP
authors.lastname: Reiss
authors.forename: Wolf-Hartmut
authors.initials: WH
authors.lastname: Meyer-Moldenhauer
authors.forename: Roland
authors.initials: R
authors.lastname: Dahlem
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D014525:Urethral Stricture / Q000601:surgery; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*