title: Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy.
abstract: OBJECTIVE
  To determine the outcomes of open vesicourethral anastomotic reconstruction (VUAR) for outlet stenosis following radical prostatectomy (RP).
  
  
  METHODS
  Review of all cases of VUAR within an IRB-approved database was performed. Preoperative factors assessed included cancer treatment modality, duration of symptoms, prior treatments, and length of defect. Outcomes reviewed included length-of-stay (LOS), complications, maintenance of patency, continence, and need for additional procedures.
  
  
  RESULTS
  Twelve cases of VUAR performed by a single surgeon (BJF) from 2004 to 2012 were identified. Surgical approaches were either abdominal (7), perineal (3), or abdominoperineal (2). All patients underwent prior RP, with 25 % having subsequent radiotherapy. Among patients with stenosis, 43 % were completely obliterated. Two cases had prior anastomotic disruption in the early postoperative period after RP. The median length of stenosis was 2.5 cm (range 1-5 cm) and median LOS was 3.0 days (range 1-7 days). At a median follow-up of 75.5 months (range 14-120 months), 92 % of men retained patency; only 25 % were continent.
  
  
  CONCLUSIONS
  In experienced hands, VUAR can restore durable patency for men afflicted with outlet stenosis after RP. Despite anatomic restoration, incontinence is likely.
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Nikolavsky
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Blakely
authors.forename: David A
authors.initials: DA
authors.lastname: Hadley
authors.forename: Paul
authors.initials: P
authors.lastname: Knoll
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Windsperger
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Terlecki
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Flynn
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014554:Urination