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

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.