Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up
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Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up. / Schüttfort, Victor; Dahlem, Roland; Kluth, Luis Alex; Pfalzgraf, Daniel; Rosenbaum, Clemens; Ludwig, Tim Alexander; Fisch, Margit; Reiß, Christoph-Philip.
in: WORLD J UROL, Jahrgang 35, Nr. 12, 12.2017, S. 1885-1890.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up
AU - Schüttfort, Victor
AU - Dahlem, Roland
AU - Kluth, Luis Alex
AU - Pfalzgraf, Daniel
AU - Rosenbaum, Clemens
AU - Ludwig, Tim Alexander
AU - Fisch, Margit
AU - Reiß, Christoph-Philip
PY - 2017/12
Y1 - 2017/12
N2 - OBJECTIVES:To re-evaluate safety and efficacy of transperineal reanastomosis (TPRA) as a viable therapeutic option in highly recurrent anastomotic strictures (AS) after radical retropubic prostatectomy (RRP).METHODS:Retrospective analysis by standardized questionnaire inquiring for recurrence of stricture, stress urinary incontinence (SUI), sexual function, satisfaction, and changes in quality of life (QoL) was performed in all patients undergoing TPRA. Validated questionnaires (ICIQ-UI, EQ-5D, and IPSS) were included.RESULTS:Median follow-up was 45.0 months. The average number of prior operations was 4.69. Success rate was 87% (20/23). Three recurrences were successfully treated via endoscopic means. All patients had urinary incontinence pre-op and post-op. Implantation of an artificial urinary sphincter (AUS) has been performed successfully in 73.9% (17/23). Rate of complications was low (8.7%; 2/23, Clavien-Dindo Grade II + III). EQ-5D-VAS showed a good general state of health (73.5/100). An improvement in QoL was noted in 63.6% (14/22) and patient satisfaction was high (72.7%; 16/22).CONCLUSIONS:This extended follow-up confirms the initial results for TPRA as an excellent treatment option for highly recurrent AS after RRP. Postoperative SUI as a consequence of transsphincteric urethral mobilization can be satisfactorily treated by the implantation of AUS. In case of AS recalcitrant to endoscopic treatment, the described procedure-even though technically challenging-represents a valuable treatment option.
AB - OBJECTIVES:To re-evaluate safety and efficacy of transperineal reanastomosis (TPRA) as a viable therapeutic option in highly recurrent anastomotic strictures (AS) after radical retropubic prostatectomy (RRP).METHODS:Retrospective analysis by standardized questionnaire inquiring for recurrence of stricture, stress urinary incontinence (SUI), sexual function, satisfaction, and changes in quality of life (QoL) was performed in all patients undergoing TPRA. Validated questionnaires (ICIQ-UI, EQ-5D, and IPSS) were included.RESULTS:Median follow-up was 45.0 months. The average number of prior operations was 4.69. Success rate was 87% (20/23). Three recurrences were successfully treated via endoscopic means. All patients had urinary incontinence pre-op and post-op. Implantation of an artificial urinary sphincter (AUS) has been performed successfully in 73.9% (17/23). Rate of complications was low (8.7%; 2/23, Clavien-Dindo Grade II + III). EQ-5D-VAS showed a good general state of health (73.5/100). An improvement in QoL was noted in 63.6% (14/22) and patient satisfaction was high (72.7%; 16/22).CONCLUSIONS:This extended follow-up confirms the initial results for TPRA as an excellent treatment option for highly recurrent AS after RRP. Postoperative SUI as a consequence of transsphincteric urethral mobilization can be satisfactorily treated by the implantation of AUS. In case of AS recalcitrant to endoscopic treatment, the described procedure-even though technically challenging-represents a valuable treatment option.
KW - Aftercare
KW - Aged
KW - Anastomosis, Surgical
KW - Constriction, Pathologic
KW - Endoscopy
KW - Germany
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications
KW - Prostatectomy
KW - Prostatic Neoplasms
KW - Quality of Life
KW - Reconstructive Surgical Procedures
KW - Recurrence
KW - Reoperation
KW - Surveys and Questionnaires
KW - Journal Article
U2 - 10.1007/s00345-017-2067-8
DO - 10.1007/s00345-017-2067-8
M3 - SCORING: Journal article
C2 - 28674908
VL - 35
SP - 1885
EP - 1890
JO - WORLD J UROL
JF - WORLD J UROL
SN - 0724-4983
IS - 12
ER -