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

To investigate the factors responsible for anastomotic strictures of the bladder neck after radical retropubic prostatectomy.

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.

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.

There are three risk factors for anastomotic stricture after radical prostatectomy: previous operations on the prostate, extravasation and asymptomatic bacteriuria.