Anastomotic strictures following radical prostatectomy: Insights into incidence, effectiveness of intervention, effect on continence, and factors predisposing to occurrence

Objectives. To examine the incidence, effectiveness of intervention, effect on continence, and factors predisposing to the occurrence of anastomotic s trictures following radical retropubic prostatectomy. Methods. Between January 1994 and June 1999, 753 radical retropubic prostat ectomies were performed by a single surgeon. Anastomotic strictures were ma naged by dilatation followed by a self-catheterization regimen. Dilatations were repeated unless more than three dilatations were required over a 9-mo nth interval. A control group representing a randomly selected group of men who did not develop anastomotic strictures was identified. The largest wid th of the midline vertical abdominal scar was measured. Results. Of the 753 radical retropubic prostatectomies, 36 (4.8%) developed an anastomotic stricture. The mean time interval between the surgical proc edure and diagnosis of the stricture was 4.22 months. Of the 26 cases of an astomotic strictures with at least 1-year follow-up, 24 (92.3%) were manage d successfully by dilatations alone. No baseline characteristics before sur gery were associated with the development of a stricture. The maximal scar width was the only factor that was associated with the development of a str icture in this study. Men with a maximal scar of greater than 10 mm were ei ght times more likely to develop strictures than men with smaller scars. Th e percentage of men who required protective pads 1 year following radical r etropubic prostatectomy in the control and stricture groups was 12.5% and 4 6.2%, respectively. Conclusions. Anastomotic strictures are relatively rare following radical p rostatectomy and have a negative effect on the development of continence. M ost men are successfully managed with dilatations alone. The development of anastomotic strictures in some men appears to be related to a generalized hypertrophic wound-healing mechanism. UROLOGY 57: 742-746, 2001. (C) 2001, Elsevier Science Inc.