Age, obesity, medical comorbidities and surgical technique are predictive of symptomatic anastomotic strictures after contemporary radical prostatectomy Journal Article

  

Authors:	Sandhu, J. S.; Gotto, G. T.; Herran, L. A.; Scardino, P. T.; Eastham, J. A.; Rabbani, F.
Article Title:	Age, obesity, medical comorbidities and surgical technique are predictive of symptomatic anastomotic strictures after contemporary radical prostatectomy
Abstract:	Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. © 2011 American Urological Association Education and Research, Inc.
Keywords:	adult; cancer surgery; major clinical study; follow up; pelvis lymph node; laparoscopic surgery; lymphadenectomy; bleeding; obesity; kidney failure; surgical approach; medical record review; retrospective study; age; postoperative complication; postoperative complications; prostatic neoplasms; body mass; disease severity; urine incontinence; prostatectomy; diabetes mellitus; surgeon; comorbidity; scoring system; dyslipidemia; prostate adenocarcinoma; robotics; hematoma; coronary artery disease; anastomotic stricture; urinoma; contracture; charlson score
Journal Title:	Journal of Urology
Volume:	185
Issue:	6
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2011-06-01
Start Page:	2148
End Page:	2152
Language:	English
DOI:	10.1016/j.juro.2011.02.003
PROVIDER:	scopus
PUBMED:	21496848
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-79955847715&partnerID=40&md5=4a15e89567271aa0ca75968a6d771cfd
Notes:	--- - "Export Date: 23 June 2011" - "CODEN: JOURA" - "Source: Scopus"

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