Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success
Purpose We describe patency outcomes and predictors of success for the endoscopic treatment of vesicourethral stenosis after radical prostatectomy. Materials and Methods A retrospective review identified 142 patients who underwent endoscopic treatment for vesicourethral stenosis after radical prosta...
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| Veröffentlicht in: | The Journal of urology 2016-05, Vol.195 (5), p.1495-1500 |
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| description | Purpose We describe patency outcomes and predictors of success for the endoscopic treatment of vesicourethral stenosis after radical prostatectomy. Materials and Methods A retrospective review identified 142 patients who underwent endoscopic treatment for vesicourethral stenosis after radical prostatectomy during a 10-year period. Clinical parameters examined were treatment modality, prior endoscopic treatment, age, concurrent radiotherapy, body mass index 35 kg/m2 or greater, diabetes and smoking. The primary outcome measure was absence of stenosis (less than 16Fr) on followup cystoscopy. Treatment modalities were divided into 5 groups of holmium laser incision, cold knife incision, electrocautery incision, dilation or UroLume® stent. Descriptive statistics as well as univariate and multivariate logistic regression were performed. Results A total of 142 patients required 292 endoscopic treatments for a mean of 2.1 treatments per patient. The success rate of a single endoscopic treatment was 44.2%. However, 91% of the patients were ultimately treated successfully with endoscopic measures with a mean followup of 9.7 months. On multivariate analysis treatment modality (OR 0.65, 95% CI 0.52–0.80, p |
| doi_str_mv | 10.1016/j.juro.2015.12.073 |
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Materials and Methods A retrospective review identified 142 patients who underwent endoscopic treatment for vesicourethral stenosis after radical prostatectomy during a 10-year period. Clinical parameters examined were treatment modality, prior endoscopic treatment, age, concurrent radiotherapy, body mass index 35 kg/m2 or greater, diabetes and smoking. The primary outcome measure was absence of stenosis (less than 16Fr) on followup cystoscopy. Treatment modalities were divided into 5 groups of holmium laser incision, cold knife incision, electrocautery incision, dilation or UroLume® stent. Descriptive statistics as well as univariate and multivariate logistic regression were performed. Results A total of 142 patients required 292 endoscopic treatments for a mean of 2.1 treatments per patient. The success rate of a single endoscopic treatment was 44.2%. However, 91% of the patients were ultimately treated successfully with endoscopic measures with a mean followup of 9.7 months. On multivariate analysis treatment modality (OR 0.65, 95% CI 0.52–0.80, p <0.001), prior failed treatment (OR 0.86, 95% CI 0.74–0.99, p=0.04) and smoking (OR 0.55, 95% CI 0.34–0.97, p=0.04) were associated with failure, while age (p=0.85), diabetes (p=0.25), radiotherapy (p=0.68) and body mass index 35 kg/m2 or greater (p=0.92) were not. Compared to holmium laser incision all modalities except UroLume were associated with treatment failure. Conclusions Most patients with vesicourethral stenosis after radical prostatectomy are treated successfully with endoscopic modalities but often require multiple procedures. Unlike anterior urethral strictures, in this specific scenario the use of repeat endoscopic treatments appears justified. Holmium laser incision may be more successful compared to other endoscopic modalities.</description><identifier>ISSN: 0022-5347</identifier><identifier>EISSN: 1527-3792</identifier><identifier>DOI: 10.1016/j.juro.2015.12.073</identifier><identifier>PMID: 26719028</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; constriction, pathologic ; Cystoscopy - methods ; dilatation ; Follow-Up Studies ; Humans ; Laser Therapy - methods ; lasers, solid-state ; Male ; Postoperative Complications ; prostatectomy ; Prostatectomy - adverse effects ; Prostatic Neoplasms - surgery ; Reoperation ; Retrospective Studies ; Stents ; Treatment Outcome ; urethra ; Urethra - surgery ; Urinary Bladder Neck Obstruction - diagnosis ; Urinary Bladder Neck Obstruction - etiology ; Urinary Bladder Neck Obstruction - surgery ; Urology</subject><ispartof>The Journal of urology, 2016-05, Vol.195 (5), p.1495-1500</ispartof><rights>American Urological Association Education and Research, Inc.</rights><rights>2016 American Urological Association Education and Research, Inc.</rights><rights>Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-608effd777f38c12ca207bb199c443e811fc3884f971facfee504c11f73cb91d3</citedby><cites>FETCH-LOGICAL-c411t-608effd777f38c12ca207bb199c443e811fc3884f971facfee504c11f73cb91d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.juro.2015.12.073$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26719028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LaBossiere, Joseph R</creatorcontrib><creatorcontrib>Cheung, Douglas</creatorcontrib><creatorcontrib>Rourke, Keith</creatorcontrib><title>Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success</title><title>The Journal of urology</title><addtitle>J Urol</addtitle><description>Purpose We describe patency outcomes and predictors of success for the endoscopic treatment of vesicourethral stenosis after radical prostatectomy. Materials and Methods A retrospective review identified 142 patients who underwent endoscopic treatment for vesicourethral stenosis after radical prostatectomy during a 10-year period. Clinical parameters examined were treatment modality, prior endoscopic treatment, age, concurrent radiotherapy, body mass index 35 kg/m2 or greater, diabetes and smoking. The primary outcome measure was absence of stenosis (less than 16Fr) on followup cystoscopy. Treatment modalities were divided into 5 groups of holmium laser incision, cold knife incision, electrocautery incision, dilation or UroLume® stent. Descriptive statistics as well as univariate and multivariate logistic regression were performed. Results A total of 142 patients required 292 endoscopic treatments for a mean of 2.1 treatments per patient. The success rate of a single endoscopic treatment was 44.2%. However, 91% of the patients were ultimately treated successfully with endoscopic measures with a mean followup of 9.7 months. On multivariate analysis treatment modality (OR 0.65, 95% CI 0.52–0.80, p <0.001), prior failed treatment (OR 0.86, 95% CI 0.74–0.99, p=0.04) and smoking (OR 0.55, 95% CI 0.34–0.97, p=0.04) were associated with failure, while age (p=0.85), diabetes (p=0.25), radiotherapy (p=0.68) and body mass index 35 kg/m2 or greater (p=0.92) were not. Compared to holmium laser incision all modalities except UroLume were associated with treatment failure. Conclusions Most patients with vesicourethral stenosis after radical prostatectomy are treated successfully with endoscopic modalities but often require multiple procedures. Unlike anterior urethral strictures, in this specific scenario the use of repeat endoscopic treatments appears justified. Holmium laser incision may be more successful compared to other endoscopic modalities.</description><subject>Aged</subject><subject>constriction, pathologic</subject><subject>Cystoscopy - methods</subject><subject>dilatation</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Laser Therapy - methods</subject><subject>lasers, solid-state</subject><subject>Male</subject><subject>Postoperative Complications</subject><subject>prostatectomy</subject><subject>Prostatectomy - adverse effects</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Treatment Outcome</subject><subject>urethra</subject><subject>Urethra - surgery</subject><subject>Urinary Bladder Neck Obstruction - diagnosis</subject><subject>Urinary Bladder Neck Obstruction - etiology</subject><subject>Urinary Bladder Neck Obstruction - surgery</subject><subject>Urology</subject><issn>0022-5347</issn><issn>1527-3792</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi0EokvhBTigHLkkeOxknSCEhKoClSq16haulncyFg5JvNgO0r49jrZw6IGTpfH3_9J8w9hr4BVw2L4bqmEJvhIcmgpExZV8wjbQCFVK1YmnbMO5EGUja3XGXsQ4cA51o8Rzdia2Cjou2g3zl3PvI_qDw-I-kEkTzanwtvhO0aFfAqUfwYzFLtHso4uFsYlCcWd6h3l8G3xMJhEmPx3fFzdLQj9RpuY-_1GGkg9x7dstiBTjS_bMmjHSq4f3nH37fHl_8bW8vvlydfHpusQaIJVb3pK1vVLKyhZBoBFc7ffQdVjXkloAi7Jta9spsAYtUcNrzFMlcd9BL8_Z21PvIfhfC8WkJxeRxtHM5JeoQXVZRyc6mVFxQjEvEwNZfQhuMuGogetVtB70KlqvojUInUXn0JuH_mU_Uf8v8tdsBj6cAMpb_nYUdERHM2YnIevSvXf_7__4KI6jm1fnP-lIcciXmbM_DTrmgN6tp14vDQ1vGgCQfwA05aYc</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>LaBossiere, Joseph R</creator><creator>Cheung, Douglas</creator><creator>Rourke, Keith</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success</title><author>LaBossiere, Joseph R ; Cheung, Douglas ; Rourke, Keith</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-608effd777f38c12ca207bb199c443e811fc3884f971facfee504c11f73cb91d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>constriction, pathologic</topic><topic>Cystoscopy - methods</topic><topic>dilatation</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Laser Therapy - methods</topic><topic>lasers, solid-state</topic><topic>Male</topic><topic>Postoperative Complications</topic><topic>prostatectomy</topic><topic>Prostatectomy - adverse effects</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Treatment Outcome</topic><topic>urethra</topic><topic>Urethra - surgery</topic><topic>Urinary Bladder Neck Obstruction - diagnosis</topic><topic>Urinary Bladder Neck Obstruction - etiology</topic><topic>Urinary Bladder Neck Obstruction - surgery</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LaBossiere, Joseph R</creatorcontrib><creatorcontrib>Cheung, Douglas</creatorcontrib><creatorcontrib>Rourke, Keith</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LaBossiere, Joseph R</au><au>Cheung, Douglas</au><au>Rourke, Keith</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success</atitle><jtitle>The Journal of urology</jtitle><addtitle>J Urol</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>195</volume><issue>5</issue><spage>1495</spage><epage>1500</epage><pages>1495-1500</pages><issn>0022-5347</issn><eissn>1527-3792</eissn><abstract>Purpose We describe patency outcomes and predictors of success for the endoscopic treatment of vesicourethral stenosis after radical prostatectomy. Materials and Methods A retrospective review identified 142 patients who underwent endoscopic treatment for vesicourethral stenosis after radical prostatectomy during a 10-year period. Clinical parameters examined were treatment modality, prior endoscopic treatment, age, concurrent radiotherapy, body mass index 35 kg/m2 or greater, diabetes and smoking. The primary outcome measure was absence of stenosis (less than 16Fr) on followup cystoscopy. Treatment modalities were divided into 5 groups of holmium laser incision, cold knife incision, electrocautery incision, dilation or UroLume® stent. Descriptive statistics as well as univariate and multivariate logistic regression were performed. Results A total of 142 patients required 292 endoscopic treatments for a mean of 2.1 treatments per patient. The success rate of a single endoscopic treatment was 44.2%. However, 91% of the patients were ultimately treated successfully with endoscopic measures with a mean followup of 9.7 months. On multivariate analysis treatment modality (OR 0.65, 95% CI 0.52–0.80, p <0.001), prior failed treatment (OR 0.86, 95% CI 0.74–0.99, p=0.04) and smoking (OR 0.55, 95% CI 0.34–0.97, p=0.04) were associated with failure, while age (p=0.85), diabetes (p=0.25), radiotherapy (p=0.68) and body mass index 35 kg/m2 or greater (p=0.92) were not. Compared to holmium laser incision all modalities except UroLume were associated with treatment failure. Conclusions Most patients with vesicourethral stenosis after radical prostatectomy are treated successfully with endoscopic modalities but often require multiple procedures. Unlike anterior urethral strictures, in this specific scenario the use of repeat endoscopic treatments appears justified. Holmium laser incision may be more successful compared to other endoscopic modalities.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26719028</pmid><doi>10.1016/j.juro.2015.12.073</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged constriction, pathologic Cystoscopy - methods dilatation Follow-Up Studies Humans Laser Therapy - methods lasers, solid-state Male Postoperative Complications prostatectomy Prostatectomy - adverse effects Prostatic Neoplasms - surgery Reoperation Retrospective Studies Stents Treatment Outcome urethra Urethra - surgery Urinary Bladder Neck Obstruction - diagnosis Urinary Bladder Neck Obstruction - etiology Urinary Bladder Neck Obstruction - surgery Urology |
| title | Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success |
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