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Outcome of patients with epithelialized cavity formation after excessive vesicourethral anastomotic leak post radical prostatectomy

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Abstract

Purpose

Excessive vesicourethral anastomotic leak (EVAL) is a rare but severe complication after radical prostatectomy (RP). Epithelialized vesicourethral cavity formation (EVCF) usually develops during prolonged catheterization. To our knowledge, there is no description of postoperative outcomes, complications, or functional assessment of these patients who received conservative therapy after EVAL.

Methods

We identified 70 patients (0.56%) with radiographic evidence of EVCF out of 12,434 patients who received RP in 2016–2020 at our tertiary care center. Postoperative radiographic cystograms (CG) were retrospectively re-examined by two urologists individually. We assessed urinary continence (UC), the need for intervention due to anastomotic stricture formation, urinary tract infection (UTI), and symphysitis during the first year of follow-up post-RP.

Results

The median age was 66 years [interquartile range (IQR) 61–70 years], the median body mass index was 27.8 kg/m2 (IQR 25.5–30.3 kg/m2), and the median prostate specific antigen before RP was 7.1 ng/ml (IQR 4.7–11.8 ng/ml). The median catheter insertion time was 44.5 days (IQR 35.2–54 days). One-year continence follow-up was available for 27 patients (38.6%), of which 22 (81.5%) reported the use of ≤ one pad, two patients reported the use of two (7.4%) pads/24 h, and three (11.1%) patients reported use > two pads/24 h. Overall, four (5.7%) patients needed surgical reintervention for anastomotic stricture, eight (11.5%) patients presented with symphysitis, and 55 (77.1%) presented with UTI.

Conclusion

UC in 81.5% 1-year post-RP suggests that conservative treatment in EVAL is a treatment option with an acceptable outcome on UC and should be considered before reintervention for anastomotic insufficiency.

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Data availability

Data assessment was performed using our prospective institutional database (FileMaker Pro 10; FileMaker, Inc.).

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Acknowledgements

There was no external financial support for this study.

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Authors and Affiliations

  1. Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Dejan K. Filipas, Markus Graefen, Thomas Steuber, Hans Heinzer, Robert J. Schulz, Mykyta Kachanov, Pierre Tennstedt, Luisa Hahn, Phillip Marks, Lukas J. Hohenhorst & Randi M. Pose

  2. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Dejan K. Filipas, Margit Fisch, Thomas Steuber, Robert J. Schulz, Tim A. Ludwig & Phillip Marks

Authors
  1. Dejan K. Filipas
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  2. Markus Graefen
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  3. Margit Fisch
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  5. Hans Heinzer
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Contributions

DKF: protocol/project development, data collection or management, data analysis, manuscript writing/editing. MG: protocol/project development, manuscript writing/editing. MF: manuscript writing/editing. TS: manuscript writing/editing. HH: manuscript writing/editing. RJS: data collection or management, data analysis, manuscript writing/editing. MK: data collection or management, manuscript writing/editing. PT: data collection or management, data analysis. LH: data collection or management, manuscript writing/editing. TL: data collection or management, data analysis, manuscript writing/editing. PM: manuscript writing/editing. JLH: manuscript writing/editing. RMP: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Randi M. Pose.

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Conflict of interest

The authors declare that they have no conflict of interest. In accordance with federal and institutional guidelines, all men signed an institutional review board-approved, protocol-specific informed consent form before study entry. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Anonymized data were used.

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Filipas, D.K., Graefen, M., Fisch, M. et al. Outcome of patients with epithelialized cavity formation after excessive vesicourethral anastomotic leak post radical prostatectomy. World J Urol 41, 2327–2333 (2023). https://doi.org/10.1007/s00345-023-04479-9

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  • DOI: https://doi.org/10.1007/s00345-023-04479-9

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