Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb;9(1):115-120.
doi: 10.21037/tau.2019.11.01.

Treatment outcomes of bladder neck contractures from surgical clip erosion: a matched cohort comparison

Vidit Sharma  1 , R Jeffrey Karnes  1 , Boyd R Viers  1
Affiliations

Treatment outcomes of bladder neck contractures from surgical clip erosion: a matched cohort comparison

Vidit Sharma et al. Transl Androl Urol. 2020 Feb.

Abstract

Vesicourethral anastomotic stenosis (VUS) from surgical clip erosion after radical prostatectomy (RP) is a rare scenario with potentially significant quality of life implications. The literature is limited to case series, and the impact of clip erosion on VUS prognosis is not known. Years 2001 to 2012 of our institutional RP registry were queried for patients with symptomatic VUS without prior strictures or radiotherapy. Patients with clip-associated VUS (caVUS) were identified and compared to a 1:3 matched cohort (based on age, Gleason score, and year of surgery) of non-caVUS patients using descriptive statistics and time to event analyses. At a median follow-up of 54 months after RP, 243 men with symptomatic VUS were identified of which 21 (8.6%) were caVUS. Robotic RPs had a higher rate of caVUS (0.5%) vs. open RPs (0.06%), P<0.01. Patients with caVUS had longer time to diagnosis after RP compared to a matched cohort of 63 non-caVUS patients (median 9.2 vs. 3.7 months after RP, P<0.01). Although patients with caVUS had a higher VUS recurrence rate after endoscopic treatment compared to patients with non-caVUS, the difference was not statistically significant on log-rank comparison (3-year VUS recurrence rate 56.4% vs. 39.4%, P=0.23). Majority of VUS recurrences were within 18 months of initial treatment. Clip erosion is responsible for 8.6% of VUS after RP, takes longer to present than non-caVUS, and was seen more commonly after a robotic RP. VUS recurrence rates are similar for caVUS and non-caVUS.

Keywords: Clip erosion; bladder neck contracture; prostate cancer; radical prostatectomy (RP); vesicourethral stenosis.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Representative images of clip-associated VUS. (A) demonstrates a vesicourethral stenosis with luminal stone that is discovered to be from clip erosion (B) once the stone is fragmented; (C) depicts a more subtle eroded clip at a vesical urethral anastomosis and (D) subsequent persistent vesicourethral anastomotic stenosis after clip extraction. VUS, vesicourethral anastomotic stenosis.
Figure 2
Figure 2
VUS recurrence-free survival for caVUS (blue) and non-caVUS (red). A high VUS recurrence rate for caVUS was demonstrated, but this difference was not statistically significant (P=0.23). caVUS, clip-associated vesicourethral anastomotic stenosis.
See this image and copyright information in PMC

References

    1. Sharma V, Meeks JJ. Open conversion during minimally invasive radical prostatectomy: impact on perioperative complications and predictors from national data. J Urol 2014;192:1657-62. 10.1016/j.juro.2014.06.029 - DOI - PubMed
    1. Bang SL, Yallappa S, Dalal F, et al. Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations. Curr Urol 2017;10:32-9. 10.1159/000447148 - DOI - PMC - PubMed
    1. Pfalzgraf D, Siegel FP, Kriegmair MC, et al. Bladder Neck Contracture After Radical Prostatectomy: What Is the Reality of Care? J Endourol 2017;31:50-6. 10.1089/end.2016.0509 - DOI - PubMed
    1. Ramirez D, Zhao LC, Bagrodia A, et al. Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology 2013;82:1430-5. 10.1016/j.urology.2013.08.018 - DOI - PubMed
    1. Giannarini G, Manassero F, Mogorovich A, et al. Cold-knife incision of anastomotic strictures after radical retropubic prostatectomy with bladder neck preservation: efficacy and impact on urinary continence status. Eur Urol 2008;54:647-56. 10.1016/j.eururo.2007.12.013 - DOI - PubMed