Factors affecting urethral stricture development after radical retropubic prostatectomy.

Objective: We determined the factors that can cause urethral stricture after radical retropubic prostatectomy.

Materials And Methods: A total of 56 patients underwent radical retropubic prostatectomy for clinically localized prostate cancer between June 2004 and July 2006. The patients were invited for cystography and removal of the urethral catheter at the 7th postoperative day if no extravasation was seen. Otherwise, the same procedures were repeated at postoperative days 14 and 21 until complete healing at urethrovesical anastomosis was observed. The patients were followed up for the occurrence of urethral stricture with PSA blood levels, residual urine assessment and uroflowmetry at least for 1 year. The impact of age, preoperative PSA level, prostate weight, biopsy Gleason score, bladder neck reconstruction, neurovascular bundle preservation, presence of a water-tight anastomosis, amount of peroperative bleeding and catheter removal time on the development of urethral stricture was evaluated with logistic regression analysis.

Results: A statistically significant correlation was observed between catheter removal time, which reflects complete healing of the urethrovesical anastomosis, and development of urethral stricture (P = 0.004). Only 1 (4%) of 25 patients whose catheter was removed on postoperative day 7 developed urethral stricture, whereas 2 of 16 (12.5%) and 6 of 15 (40%) patients whose catheters were removed on postoperative days 14 and 21 developed urethral strictures. Additionally, patients with postoperative urethral strictures were found to be slightly older than those without (67.4 +/- 4.5 vs. 63.1 +/- 6.5, P = 0.048).

Conclusion: Our study showed that early healing of vesico-urethral anastomosis may allow early catheter removal and results in decreased rates of urethral stricture formation.