Bladder neck strictures after radical retropubic prostatectomy: still an unsolved problem.

OBJECTIVE: To investigate the factors responsible for anastomotic strictures of the bladder neck after radical retropubic prostatectomy. PATIENTS AND METHODS: Of 239 consecutive patients who underwent radical retropubic prostatectomy between 1987 and 1996, 36 (15%) developed anastomotic strictures after surgery. The influence of tumour stage, previous prostatic surgery, urinary extravasation and postoperative bacteriuria were assessed. RESULTS: In 21 patients (58%), the bladder neck stricture occurred within 3 months of surgery, in 11 (30%) at 4-12 months after surgery and in four (11%) more than 12 months after surgery; three of these also had local recurrence. Advanced tumour stage and positive margins did not correlate with a higher stricture rate, nor was there a significant difference in stricture rates with three or four anastomotic sutures. However, extravasation at the time of catheter removal (16 of 36 patients (44%) with vs 34 of 183 patients without (19%) stricture, bacteriuria of > 10(6) c.f.u./mL at the time of catheter removal (stricture group 21 of 36 patients (58%) stricture with vs 71 of 203 (35%) without) and previous prostatic surgery (TURP or open surgery, stricture in 28% of those previously operated vs 13% with no previous surgery) were significant risk factors. CONCLUSION: There are three risk factors for anastomotic stricture after radical prostatectomy: previous operations on the prostate, extravasation and asymptomatic bacteriuria.

Complete androgen deprivation prior to radical prostatectomy in patients with stage T3 cancer of the prostate.

Twenty-one patients with stage T3 cancer of the prostate underwent complete androgen deprivation (LH-RH agonist and flutamide) for 3 months prior to radical prostatectomy. Two problems were to be dealt with: the decrease in the volume of the prostate, and the possibility of downstaging (= pT less than pT3 according to the UICC 1987 classification) of the prostatic cancer. A decrease in the volume was noted in each case. A downstaging effect (pT in comparison to T stage) was noted in 33% of the patients. The downstaging effect was noted in 75% of grade 1 tumor, in 31% of grade 2 tumors, but not in grade 3 tumors.

[The urological spiral. A real alternative to the indwelling catheter? Experience in 23 patients]. / Die urologische Spirale. Eine echte Alternative zum Verweilkatheter? Erfahrungsbericht an 23 Patienten.

Our experiences are reported with the "intraprostatic spiral" in 23 high-risk patients with prostatic adenoma. The intraprostatic spiral was used only in selected patients for medical indications. Patients confined to bed as well as those with detrusor instability or secondary dilatation of the upper urinary tract were excluded. 14 of our patients (60.8%) showed excellent voiding ability, without residual urine and all of them were fully satisfied with the functioning of the prostatic spiral. The longest indwelling time in this group is now about 36 months. 9 of 23 patients (39.2%) were not satisfied with their prostatic spiral. In all of them, the spiral had to be removed later on. Urinary stress incontinence was the main reason for removal. Two thirds of the patients who were not satisfied with the functioning of the prostatic spiral, had a marked decrease in detrusor function. This is a major reason for unsatisfying prostatic spiral function. On average, the prostatic spirals had to be exchanged after 15-18 months because of incrustation. Nearly all patients (21 of 23) showed asymptomatic bacteriuria.

Organ-preserving surgery in patients with urothelial tumors of the upper urinary tract.

The Austrian Urological Oncology Group reports on 55 organ-preserving operations in 52 patients with tumors of the upper urinary tract epithelium. The data were gathered from 12 urological departments in the country. There was no evidence of distant metastases in any of the patients at the time of surgery. The observation period ranged from 0.5 to 12 years. 69.2% (36 of 52) of the patients were alive and recurrence-free at the time of data collection, after a mean observation period of 41.4 months. 9.6% died for reasons other than cancer after an average of 18.8 months, and 21.2% were still alive with or had died due to recurrent tumors. The recurrence rate after open surgery was similar in tumors of the upper ureter or pelvis (15.3%) as in tumors of the lower ureter (17.6%). After endoscopic treatment 4 of 9 patients showed recurrences. 92% (22 of 24) of the patients with no compelling indication for organ-preserving therapy were alive and recurrence-free or had died due to other causes. Therefore organ-preserving surgery appears to be appropriate in tumors of the upper urinary tract epithelium.