title: Surgical approach to vesicourethral anastomotic stricture following radical prostatectomy.
abstract: BACKGROUND
  Vesicourethral anastomotic stricture following prostatectomy is uncommon but represents a challenge for reconstructive surgery and has a significant impact on quality of life. The aim of this study was to relate our experience in managing vesicourethral anastomotic strictures and present the treatment algorithm used in our institution.
  
  
  METHODS
  We performed a descriptive, retrospective study in which we assessed the medical records of 45 patients with a diagnosis of vesicourethral anastomotic stricture following radical prostatectomy. The patients were treated in the same healthcare centre between January 2002 and March 2015. Six patients were excluded for meeting the exclusion criteria. The stricture was assessed using cystoscopy and urethrocystography. The patients with patent urethral lumens were initially treated with minimally invasive procedures. Open surgery was indicated for the presence of urethral lumen obliteration or when faced with failure of endoscopic treatment. Urinary continence following the prostatectomy was determinant in selecting the surgical approach (abdominal or perineal).
  
  
  RESULTS
  Thirty-nine patients treated for vesicourethral anastomotic stricture were recorded. The mean age was 64.4 years, and the mean follow-up was 40.3 months. Thirty-three patients were initially treated endoscopically. Seventy-five percent progressed free of restenosis following 1 to 4 procedures. Twelve patients underwent open surgery, 6 initially due to obliterative stricture and 6 after endoscopic failure. All patients progressed favourable after a mean follow-up of 29.7 months.
  
  
  CONCLUSIONS
  Endoscopic surgery is the initial treatment option for patients with vesicourethral anastomotic strictures with patent urethral lumens. Open reanastomosis is warranted when faced with recalcitrant or initially obliterative strictures and provides good results.
authors.affiliation: Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: C R
authors.initials: CR
authors.lastname: Giudice
authors.affiliation: Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: F J M
authors.initials: FJ
authors.lastname: D'Alessandro
authors.affiliation: Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: guillermo.galarza@hospitalitaliano.org.ar.
authors.forename: G A
authors.initials: GA
authors.lastname: Galarza
authors.affiliation: Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: D S
authors.initials: DS
authors.lastname: Fernández
authors.affiliation: Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: O H
authors.initials: OH
authors.lastname: Damia
authors.affiliation: Sector de Cirugía Uretral y Genital Reconstructiva, Servicio de Urología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: G A
authors.initials: GA
authors.lastname: Favre
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods; D012189:Retrospective Studies; D014525:Urethral Stricture / Q000150:complications / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Cáncer de próstata; Estenosis de anastomosis uretro-vesical; Prostate cancer; Prostatectomía radical; Radical prostatectomy; Vesicourethral anastomotic stricture