Factors predisposing to the development of anastomotic strictures in a single-surgeon series of radical retropubic prostatectomies.

Abstract

To determine the rate of anastomotic stricture (AS) after radical retropubic prostatectomy (RRP) performed by one experienced surgeon, and to identify factors predisposing to its formation. In all, 708 men were prospectively monitored for the development of AS after RRP. Potential risk factors for AS were analysed. There were no significant differences in age, Gleason score, nerve-sparing status, intraoperative blood loss, degree of extravasation on initial cystography, or duration of the indwelling urinary catheter between men who developed AS and men who did not. The mean postoperative blood loss was significantly higher in men who developed AS. The incidence of AS was also significantly higher in men whose bladder necks were reconstructed more narrowly. The amount of bleeding and the calibre of the reconstructed bladder neck were significantly associated with AS formation after RRP. The development of a haematoma from bleeding might explain the increased likelihood of AS. The mechanism of AS formation is unrelated to the degree of urinary extravasation on cystography, providing that a urinary catheter is left indwelling until extravasation resolves.