Endoscopic management of vesicourethral anastomotic stenosis after radical prostatectomy: final outcomes defined by urethral patency and continence.

BACKGROUND

Vesicourethral anastomotic stenosis (VUAS) remains a challenging sequela of radical prostatectomy (RP).

OBJECTIVES

To evaluate endoscopic outcomes in men with VUAS using a patient-centred composite endpoint of concurrent urethral patency and continence.

DESIGN

Retrospective, single-centre consecutive case series.

METHODS

We analysed 60 consecutive men treated endoscopically for VUAS (2014-2023). Primary endpoints were urethral patency (passage of a 20F catheter at 6-month follow-up) and continence (0-1 pad/day at last follow-up; for men with an artificial urinary sphincter (AUS), assessed after device activation). Secondary endpoints included AUS implantation and complications. Subgroup comparisons by prior pelvic radiotherapy (RTx) were performed using Fisher's exact and Mann-Whitney tests.

RESULTS

Median follow-up was 40 months. Patency was achieved in 45/60 (75%). Continence was achieved in 22/60 (36.7%): 5 men remained continent without AUS and 17 became continent after AUS; 4/21 AUS required explant for erosion. Composite success (patency plus continence) occurred in 20/60 (33.3%). Prior RTx was not significantly associated with patency, continence, composite success, or AUS implantation. Three men required urinary diversion for pubic bone fistulation and three were diagnosed with bladder cancer (no AUS implanted). Seventeen patients declined AUS despite persistent stress urinary incontinence.

CONCLUSION

Endoscopic treatment restores urethral patency in most men with post-RP VUAS, but the final patient-centred outcome of simultaneous patency and continence is achieved in one-third. These data may support shared decision-making regarding expectations and staged continence surgery.

TRIAL REGISTRATION: Not applicable.