Salvage prostatectomy with continent catheterizable urinary reconstruction: A novel approach to recurrent prostate cancer after radiation therapy

Purpose: Salvage prostatectomy after full dose radiation therapy is associa ted with a high risk of urinary incontinence. We evaluated the complication s of salvage prostatectomy with continent catheterizable reconstruction and its impact on urinary incontinence. Materials and Methods: Between August 1995 and February 1999, 13 patients w ith biopsy proved, locally recurrent prostate cancer after radiation therap y underwent salvage prostatectomy with complete bladder neck closure and re construction with an appendicovesicostomy to the native bladder in 9 and il eovesicostomy in 4. Results: There were no intraoperative complications. Four patients had seri ous complications necessitating reoperation, including a vesicourethral fis tula requiring delayed cystectomy, wound dehiscence with disruption of the appendicovesical anastomosis, leakage from the small bowel anastomosis that resulted in sepsis and death, and stomal stenosis requiring delayed stomal revision in 1 each. Of 12 patients 2 (17%) used pads for incontinence, whi le 10 were dry during the day and night with a catheterization interval of 2 to 6 hours. Conclusions: Salvage prostatectomy with continent catheterizable reconstruc tion is a technically challenging operation with the potential for serious complications. The postoperative continence rate is excellent and appears s uperior to those in the literature for salvage prostatectomy and vesicouret hral anastomosis.