title: Transrectal ultrasonography-guided injection of long-acting steroids in the treatment of recurrent/resistant anastomotic stenosis after radical prostatectomy.
abstract: OBJECTIVE
  Different techniques have been used for the treatment of patients with anastomotic stenosis after radical prostatectomy (RP). In this retrospective study, we analyzed our experience with urethral dilation and consecutive transrectal ultrasonography (TRUS)-guided injections of long-acting steroids in the scar area.
  
  
  METHODS
  We reviewed the records of patients who underwent RP in our department from 2002 to 2010 and presented to the outpatient clinics with symptomatic anastomotic stenosis. Patients were treated with: Urethral dilation, cold knife (CK) urethrotomy, transurethral resection (TUR) of stenosis and dilation/resection of the strictures with consecutive TRUS-guided injection of a long-acting steroid (dilation+TRUS-steroids). Patients remained under follow-up, which included the assessment of voiding and continence patterns, as well as cystourethroscopy.
  
  
  RESULTS
  In 32 (10.8%) patients, symptomatic anastomotic stenosis was diagnosed. Initial urethral dilation succeeded in only 3 (10.3%) patients; thus, 29 remained with recurrent/resistant stenosis. Urethral dilation+TRUS-steroids was performed in 14 patients, while 8 patients underwent CK and in 7 TUR was performed. Patients in the dilation+TRUS-steroids group had lower re-treatment rates, and none of these patients became incontinent. Patients in the TUR group needed no re-treatment; however, they had the highest incontinence rate (57.1%). As a result, the highest efficiency quotient was in the dilation+TRUS-steroids with the lowest in the TUR group.
  
  
  CONCLUSIONS
  Urethral dilation with consecutive TRUS-guided injections of steroids has the highest efficiency quotient and can be performed under local anesthesia with a low risk of incontinence.
authors: Barzilai Medical Center, Ashkelon, Israel. kravchick.sergey@gmail.com
authors: Sergey
authors: S
authors: Kravchick
authors: Leonid
authors: L
authors: Lobik
authors: Ronit
authors: R
authors: Peled
authors: Shmuel
authors: S
authors: Cytron
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003558:Cystoscopy; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D012007:Rectum; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone