Risk factors for vesicourethral anastomotic stricture after radical prostatectomy

Objectives. Preoperative comorbidities associated with microvascular diseas e may contribute to the development of bladder neck contracture (BNC) by al teration of anastomotic healing, We investigated potential risk factors for development of BNC after radical prostatectomy (RP) and reviewed managemen t of this complication. Methods. A retrospective review of 467 consecutive patients (mean age 63.2 years) undergoing RP between 1991 and 1999 was performed. In all cases, the bladder neck was tailored to 20 to 22F in a racket handle fashion. After m ucosal eversion of the reconstructed bladder neck, a mucosa-to-mucosa vesic ourethral anastomosis was created over an 18 to 22F catheter using 4 to 6 a nastomotic sutures. The relationship between comorbidities identified preop eratively by patient interview and medical record review (coronary artery d isease [CAD], diabetes mellitus [DM], hypertension [HTN], cerebral vascular accident, chronic obstructive pulmonary disease, and smoking history) and the incidence of BNC was determined. Risk factors including prior transuret hral prostatectomy (TURP), estimated blood loss (EBL), and operative time ( OR time) were also evaluated. Factors were evaluated for their ability to p redict BNC using both univariate and multivariate analysis. Treatment resul ts for BNC were also assessed. Results. A total of 52 (11.1%) patients developed BNC. Current cigarette sm oking resulted in a significantly higher (26%) rate of BNC (P < 0.001). The BNC rate was also increased in patients with CAD (26%, P < 0.001), HTN (19 %, P = 0.015), and DM (21%, P = 0.030). Average OR time was longer (271 ver sus 249 minutes, P = 0.025) and EEL was greater (1639 versus 1092 mt, P < 0 .001) in patients developing a BNC. In multivariate analysis, current cigar ette smoking was the strongest predictor of BNC and independent of other fa ctors (P < 0.001). BNC was not related to prior TURF, type of anastomotic s uture used, size of catheter, or duration of catheterization. Patients were treated with transurethral dilation (73%) or transurethral incision (27%) and 58% responded to the initial treatment. No patient became incontinent a s a result of the treatment for BNC. Conclusions. Several comorbidities associated with microvascular disease ar e significant risk factors for development of BNC after RP. Current cigaret te smoking in particular is a strong predictor. Transurethral dilation and transurethral incision are equally effective as initial treatment of BNC. U ROLOGY 56: 96-100, 2000. Published by Elsevier Science Inc.