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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injection
BJU International, Volume 102, No. 7, Year 2008
Notification
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Description
OBJECTIVE: To present our experience with the management of recurrent and resistant anastomotic stenosis following radical prostatectomy (RP) using transurethral laser incision of the stenotic area and injection of steroids. PATIENTS AND METHODS: Between January 1999 and April 2006, we evaluated 24 patients with anastomotic stenosis that would not allow the passage of the flexible cystoscope (17 F). Using the paediatric 7.5 F Olympus scope and a 550-μm fibre holmium laser, deep incisions were cut at the 3 and 9 o'clock positions at the bladder neck, and then triamcinolone was injected at the incision sites. Another session was then scheduled for office cystoscopy 6 weeks later, and if that showed evidence of annularity, another incision was made, as described above. RESULTS: All 24 patients had RP for localized disease, 21 were retropubic and two were perineal, and one laparoscopic. Five patients had adjuvant radiotherapy. The mean patient age was 64 years. Nineteen (79%) patients had previous attempts to open the bladder neck: eight patients had dilatation, eight patients had internal urethrotomy, five patients underwent transurethral resection of the bladder neck, and six patients had open surgical intervention. The procedure was done once in 17 patients, and twice in seven patients. After a mean (range) follow up of 24 (6-72) months, 19 patients (83%) had a well-healed and widely patent bladder neck. Of the 24 patients, 17 had urinary incontinence (UI) associated with the bladder neck contracture. An artificial urinary sphincter was implanted in 11 patients, three of which had to be explanted for malfunction in two, and erosion in one. CONCLUSION: Holmium laser bladder neck incision and steroid injection for anastomotic stenosis after RP had a success rate of 83% in this small series. It can be used safely as a primary treatment, or in some cases, for resistant and recurrent stenosis. It appears that insertion of an artificial sphincter can be done in patients with UI when the bladder neck remains patent for at least 8 weeks. © 2008 The Authors.
Authors & Co-Authors
Eltahawy, Ehab A.
Egypt, Cairo
Ain Shams University Hospitals
Gur, Uri
United States, Norfolk
Eastern Virginia Medical School
Virasoro, Ramon
Argentina, Buenos Aires
Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno
Schlossberg, Steven M.
United States, Norfolk
Eastern Virginia Medical School
Jordan, Gerald H.
United States, Norfolk
Eastern Virginia Medical School
Statistics
Citations: 105
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1111/j.1464-410X.2008.07919.x
ISSN:
14644096
e-ISSN:
1464410X
Research Areas
Cancer
Health System And Policy
Study Design
Randomised Control Trial