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To investigate the predictors of recurrence and of de novo incontinence in patients treated by transurethral incision or resection for vesico-urethral anastomotic stenosis (VUAS) after radical prostatectomy. All patients undergoing endoscopic treatment for VUAS between March 2009 and October 2016 were identified in our multi-institutional database. Digital chart reviews were performed and patients contacted for follow-up. Recurrence was defined as any need for further instrumentation or surgery, and de-novo-incontinence as patient-reported outcome. Of 103 patients undergoing endoscopic VUAS treatment, 67 (65%) underwent transurethral resection (TR) and 36 (35%) transurethral incision (TI). TI was performed more frequently as primary treatment compared to TR (58% vs. 37%; p = 0.041). Primary and repeated treatment was performed in 46 (45%) and 57 patients (55%), respectively. Overall, 38 patients (37%) had a history of radiation therapy. There was no difference in time to recurrence for primary vs repeat VUAS treatment, previous vs no radiation, TR compared to TI (all p > 0.08). Regarding treatment success, no difference was found for primary vs. repeat VUAS treatment (50% vs. 37%), previous radiation vs. no radiation (42% vs. 43%), and TR vs. TI (37% vs. 53%; all p ≥ 0.1). Postoperative de novo incontinence was more common after TI vs. TR (31% vs. 12%; p = 0.032), no difference was observed for previous radiation therapy vs. no radiation therapy (18% vs. 18%; p > 0.9) or primary vs. repeat VUAS treatment (22% vs. 16%; p = 0.5). VUAS recurrence after endoscopic treatment is not predictable. Endoscopic treatment with TI showed a higher risk for de novo incontinence than TR, and previous irradiation and the number of treatments do not influence incontinence.

To evaluate urethral catheter (UC) versus suprapubic tube (SPT) without stenting the anastomosis at robot-assisted radical prostatectomy (RALP) regarding surgical outcome and catheter-associated discomfort. One year after surgery, continence and patient satisfaction were evaluated. Sixty-two patients undergoing RALP were prospectively randomized to urinary drainage with UC or with SPT. Functional results were assessed with standardized questionnaires (IPSS, IPSS Bother Score, IIEF and Visual Analogue Scale) preoperatively, after catheter removal and 1 year after surgery. Moreover, bother by the catheter as well as pain due to the catheter was assessed. At personal hygiene, SPT was significantly less bothersome on the day of surgery as well as POD 1–6. Pain caused by the catheter did not differ significantly between the two groups except for POD 5 and 6, when the SPT performed significantly better. Differences regarding voiding parameters after catheter removal did not reach statistical significance. One year after surgery, no significant difference between the two groups was found regarding urinary function and IPSS. Though not statistically significant either, the need for the incision of bladder neck contracture (BNC) in two patients in the UC group is of note, as in the SPT group, no BNC occurred. Draining the bladder with SPT only is a feasible option in patients undergoing RALP. Patients with SPT are significantly less bothered by the catheter at personal and genital hygiene compared to UC. The risk of BNC seems to be reduced in the SPT group.

The aim of the study was to externally validate the Zonal NePhRO Score (ZNS) published in 2014 as latest and superior nephrometry score in terms of prediction of perioperative complications and outcome of open partial nephrectomies (OPNs). We identified 200 consecutive patients who underwent OPN. Analysis of preoperative CT or MRI scans and retrospective analysis of the patients’ clinical records were performed. Tumour complexity was stratified according to the ZNS into three categories: low (4–6), moderate (7–9) and high (10–12) complexity. Predictors for perioperative complications and surgical parameters were identified using univariate and multivariate logistic regression. Tumour complexity was graded in 19.8 % of the cases as low, in 50.3 % as moderate and in 29.9 % as high. In the multivariate analysis, ZNS was significantly associated with a higher complication rate (OR 1.25, 95 % CI 1.04–1.49, p = 0.014), longer ischaemia time (IT) (β = 1.19, 95 % CI 0.33–2.05, p = 0.007), postoperative drop of estimated glomerular filtration rate (eGFR) (β = −1.86, 95 % CI −3.71 to −0.01, p = 0.049) and opening of the collecting system (CS) (OR 1.72, 95 % CI 1.40–2.10, p

To evaluate safety and efficacy of open transperineal reanastomosis (TPRA) for highly recurrent anastomotic strictures (AS) after radical prostatectomy. While the majority of AS can be managed successfully by endoscopic treatment, in highly recurrent AS, open reanastomosis represents a viable therapeutic option. Retrospective analysis by standardized questionnaire, inquiring for recurrence, incontinence, sexual function, satisfaction and changes in quality of life (QoL) in 15 patients undergoing TPRA 08/2007–03/2010. Mean patient age was 65 years (51–75) and mean follow-up 20.5 months (5.8–37.0). Success rate was 93.3 % (14/15). The single recurrence was successfully treated by cold knife incision. Incontinence was found in 93.3 % (14/15) preoperatively and aggravated in 60 % (9/15) after surgery; no de novo incontinence occurred. Implantation of an artificial urinary sphincter (AUS) has been performed successfully in 10 patients, 2 refused implantation and 2 are scheduled for surgery. Erectile dysfunction was present in 86.7 % (13/15); 13.3 % (2/15) reported a severely declined rigidity. Compared to preoperative status, 33.3 % (5/15) complained about impaired erectile function after TPRA. A good or very good subjective overall health status and an improvement in QoL were noted in 86.7 % (13/15). Patient satisfaction with the outcome of TPRA was high or very high in 13; two were undecided. After repeated endoscopic treatment, TPRA is a valuable therapeutic option in selected patients with an overall success rate of 93.3 % (14/15) for anastomotic patency, which can even be raised to 100 % by further transurethral surgery. Incontinence can be easily treated by implantation of an AUS.

To assess bothersome results of surgery and changes in quality of life (QoL) in patients with redo-urethroplasty, comparing the functional results of penile and bulbar cases. As after previous urethroplasty scar tissue formation is likely to occur, less favorable functional results than at primary repair could be expected. Yet data on these items for techniques currently used are limited. Retrospective analysis with standardized questionnaire including 33 consecutive patients treated with redo-urethroplasty for bulbar or penile strictures. Previous surgeries, recurrence rate, complications, incontinence, erectile function, satisfaction with the surgery and QoL were assessed. Overall success rate was 78.8 %, number of previous open urethroplasty once in 24 patients (72.7 %), and more than once in 9 (27.3 %). Urinary stress incontinence Grade I occurred in 5 patients (15.2 %) and Grade II in 2 patients (6.1 %). In 24 patients (72.7 %), no penile shortening occurred and in 28 (84.8 %), no deviation was observed. Eight patients (24.2 %) reported their glans sensitivity to be altered, in 3 (9.1 %) a disturbing alteration occurred. Overall satisfaction with the surgery was high (70 %), and an improvement in QoL was seen in 72.7 % (24 patients). Urethroplasty after failed open repair gives good functional results and shows a high patient satisfaction rate. However, results are not quite as good as for primary repair, emphasizing the importance of a successful primary repair.