The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study

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ABSTRACT

BACKGROUND:

Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life.

OBJECTIVES:

To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS.

DESIGN AND SETTING:

Retrospective cross-sectional single-center study on data covering January 2009 to December 2019.

METHODS:

Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS.

RESULTS:

Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence.

CONCLUSIONS:

VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

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Most cited references 34

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Colin Begg, Peter T. Scardino, Deborah Schrag … (2002)

Recent studies of surgery for cancer have demonstrated variations in outcomes among hospitals and among surgeons. We sought to examine variations in morbidity after radical prostatectomy for prostate cancer. We used the Surveillance, Epidemiology, and End Results-Medicare linked data base to evaluate health-related outcomes after radical prostatectomy. The rates of postoperative complications, late urinary complications (strictures or fistulas 31 to 365 days after the procedure), and long-term incontinence (more than 1 year after the procedure) were inferred from the Medicare claims records of 11,522 patients who underwent prostatectomy between 1992 and 1996. These rates were analyzed in relation to hospital volume and surgeon volume (the number of procedures performed at individual hospitals and by individual surgeons, respectively). Neither hospital volume nor surgeon volume was significantly associated with surgery-related death. Significant trends in the relation between volume and outcome were observed with respect to postoperative complications and late urinary complications. Postoperative morbidity was lower in very-high-volume hospitals than in low-volume hospitals (27 percent vs. 32 percent, P=0.03) and was also lower when the prostatectomy was performed by very-high-volume surgeons than when it was performed by low-volume surgeons (26 percent vs. 32 percent, P<0.001). The rates of late urinary complications followed a similar pattern. Results for long-term preservation of continence were less clear-cut. In a detailed analysis of the 159 surgeons who had a high or very high volume of procedures, wide surgeon-to-surgeon variations in these clinical outcomes were observed, and they were much greater than would be predicted on the basis of chance or observed variations in the case mix. In men undergoing prostatectomy, the rates of postoperative and late urinary complications are significantly reduced if the procedure is performed in a high-volume hospital and by a surgeon who performs a high number of such procedures.

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Urethral strictures.

D Andrich, William R Mundy (2010)

What's known on the subject? and What does the study add? Urethral strictures are common and increasingly common in an ageing population. The treatment is controversial and particularly the relative roles of urethrotomy or urethral dilatation on the one hand and urethroplasty on the other. This review aims to provide a comprehensive overview of the subject including less commonly discussed issues such as the history and pathology of stricture disease. We would hope that a comprehensive overview of the subject will give a sharper perspective to aid the investigation and management of patients with urethral strictures. © 2010 BJU INTERNATIONAL. NO CLAIM TO ORIGINAL US GOVERNMENT WORKS.

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Rating the Burn Scar

J Kermode, J. Smith, E Mclver … (1990)

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Author and article information

Contributors

Ismail Selvi: Role: conceptualization (equal), data curation (equal), formal analysis (equal), investigation (equal), methodology (equal), project administration (equal), resources (equal), supervision (supporting), validation (equal), writing-original draft (lead) and writing-review and editing (equal);

Ali Ihsan Arik: Role: data curation (equal), formal analysis (equal), investigation (equal), resources (equal), supervision (supporting) and validation (equal);

Mehmet Sinan Basay: Role: data curation (equal), formal analysis (equal), investigation (equal), resources (equal), supervision (supporting) and validation (equal);

Halil Basar: Role: conceptualization (equal), data curation (equal), formal analysis (equal), investigation (equal), methodology (equal), project administration (equal), resources (equal), supervision (lead), validation (equal), visualization (equal) and writing-review and editing (equal).

Journal

Journal ID (nlm-ta): Sao Paulo Med J

Journal ID (iso-abbrev): Sao Paulo Med J

Journal ID (publisher-id): Sao Paulo Med J

Title: São Paulo Medical Journal

Publisher: Associação Paulista de Medicina - APM

ISSN (Print): 1516-3180

ISSN (Electronic): 1806-9460

Publication date (Electronic): 26 April 2021

Publication date Collection: 2021

Volume: 139

Issue: 3

Pages: 241-250

Affiliations

[I ] originalMD. Physician, Department of Urology, Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey

[II ] originalMD. Physician, Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey.

[III ] originalMD. Physician, Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey.

[IV ] originalMD. Professor, Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey.

Author notes

Address for correspondence: Ismail Selvi. Department of Urology, Karabük University Training and Research Hospital, 78200, Karabük, Turkey. Tel. +90 370 415 80 00. Fax. +90 370 412 56 28. E-mail: ismselvi33@ 123456hotmail.com

Authors’ contributions: All authors actively contributed to discussion of the results of the study, and reviewed and approved the final version to be released

Conflict of interest: None

Article

DOI: 10.1590/1516-3180.2020.0349.R1.28012021

PMC ID: 9625006

PubMed ID: 33909829

SO-VID: 368536e4-cbf3-457e-8b69-7458842b6ff0

License:

This is an open access article distributed under the terms of the Creative Commons license.

History

Date revision received : 26 June 2020

Date received : 08 December 2020

Date accepted : 28 January 2021

Page count

Figures: 2, Tables: 3, Equations: 0, References: 29, Pages: 10

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The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study

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ABSTRACT

BACKGROUND:

OBJECTIVES:

DESIGN AND SETTING:

METHODS:

RESULTS:

CONCLUSIONS:

Related collections

SciELO Brazil

Most cited references 34

Variations in morbidity after radical prostatectomy.

Urethral strictures.

Rating the Burn Scar

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