Age, Obesity, Medical Comorbidities and Surgical Technique are Predictive of Symptomatic Anastomotic Strictures After Contemporary Radical Prostatectomy
| Autor: | Jaspreet S. Sandhu, Luis A. Herran, Geoffrey Gotto, Peter T. Scardino, James A. Eastham, Farhang Rabbani |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Laparoscopic radical prostatectomy Urology medicine.medical_treatment Urinary Bladder Constriction Pathologic Adenocarcinoma Anastomosis Surgical anastomosis Urethra Risk Factors medicine Humans Obesity Prospective Studies Transurethral resection of the prostate Prostatectomy business.industry Anastomosis Surgical Age Factors Prostatic Neoplasms Middle Aged medicine.disease Surgery Prostate-specific antigen Stenosis business Complication |
| Zdroj: | Journal of Urology. 185:2148-2152 |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | Anastomotic strictures are relatively common after radical prostatectomy and are associated with significant morbidity, often requiring multiple surgical interventions. There is controversy in the literature regarding which factors predict the development of anastomotic strictures. In this study we determined predictors of symptomatic anastomotic strictures following contemporary radical prostatectomy.Between 1999 and 2007, 4,592 consecutive patients underwent radical prostatectomy without prior radiotherapy at our institution. Data were collected from prospective surgical and institutional morbidity databases, and retrospectively from inpatient and outpatient medical and billing records. Cases were assigned a Charlson score to account for comorbidities. Complications were graded according to the modified Clavien classification.Open radical prostatectomy was performed in 3,458 men (75%) and laparoscopic radical prostatectomy was performed in 1,134 (25%). The laparoscopic radical prostatectomy group included 97 robotic-assisted cases. Median patient age was 59.5 years (IQR 54.7, 64.2). Symptomatic anastomotic strictures developed in 198 patients (4%) after a median postoperative followup of 3.5 months (IQR 2.1, 6.1). On multivariate analysis significant predictors included patient age, body mass index, Charlson score, renal insufficiency, individual surgeon, surgical approach and the presence of postoperative urine leak or hematoma.Patient factors as well as technical factors influence the development of symptomatic anastomotic strictures following contemporary radical prostatectomy. The impact of these factors is influenced by the individual surgeon and the approach used. |
| Databáze: | OpenAIRE |
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