1873 PREDICTORS OF BLADDER NECK CONTRACTURE FOLLOWING RADICAL PROSTATECTOMY (2010)

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 20101873 PREDICTORS OF BLADDER NECK CONTRACTURE FOLLOWING RADICAL PROSTATECTOMY Geoffrey Gotto, Jaspreet Sandhu, Luis Herran Yunis, James Eastham, Peter Scardino, and Farhang Rabbani Geoffrey GottoGeoffrey Gotto More articles by this author , Jaspreet SandhuJaspreet Sandhu More articles by this author , Luis Herran YunisLuis Herran Yunis More articles by this author , James EasthamJames Eastham More articles by this author , Peter ScardinoPeter Scardino More articles by this author , and Farhang RabbaniFarhang Rabbani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1813AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of bladder neck contracture (BNC) following radical prostatectomy (RP) in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database is 8.4%. BNC is associated with significant morbidity and often requires surgical intervention. Established predictors of BNC include age and body mass index (BMI) but there is a paucity of literature on this topic. The objective of this study was to determine predictors of BNC following RP. METHODS Between 01-1999 and 06-2007, 4592 consecutive patients underwent RP at our institution. Data was collected from a prospective surgical and institutional morbidity database as well as retrospectively from inpatient and outpatient medical and billing records. Patients were assigned a modified Charlson score to account for comorbidities as well as age. Urinoma or urine leak was defined as evidence of extravasation or fluid collection on an imaging study consistent with a urinoma or drain fluid creatinine ≥50% above serum creatinine. The definition of hematoma was postoperative bleeding at the surgical site. Complications were graded according to the modified Clavien classification. RESULTS Open RP was performed in 3458 men (75%) and minimally-invasive RP (MIRP) was performed in 1134 (25%). The MIRP group included 97 robotic-associated cases. Prior treatment in 246 patients consisted of chemotherapy (n=45) or hormonal therapy (n=224). Median patient age was 59.5 (interquartile range (IQR): 54.7, 64.2). In total, 198 patients developed a BNC after a median post-operative follow-up of 3.5 months (IQR: 2.1, 6.1). As shown in Table 1, significant predictors of BNC on multivariate Cox proportional hazards analysis included modified Charlson score, BMI, RP approach, renal insufficiency, post-operative urinoma or urine leak, and post-operative hematoma. When surgeon was accounted for in the model, RP approach, urinoma or urine leak, and renal insufficiency were no longer significant predictors. CONCLUSIONS Surgeons have different rates of BNC following RP. Differences in RP approach, post-operative urinoma or urine leak, and renal insufficiency appear to be the main drivers in these differences. The LP approach was associated with a significantly lower rate of BNC following RP. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e727-e728 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Geoffrey Gotto More articles by this author Jaspreet Sandhu More articles by this author Luis Herran Yunis More articles by this author James Eastham More articles by this author Peter Scardino More articles by this author Farhang Rabbani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...