Factors affecting urethral stricture formation after radical prostatectomy

Background and Aim: Urethral stricture (US) after radical prostatectomy (RP) is a troublesome complication. Recent studies reported decreasing frequency of US after RP. Nevertheless, US still remains as a difficult condition to treat. The aim of this study is to evaluate factors that lead to post-RP US. Factors affecting the time of US and the development of recurrent US were also analysed. Materials and Methods: From May 2008 to December 2016, we evaluated the data of 1006 patients who underwent RP for prostate cancer at Ege University Faculty of Medicine Urology Department and met inclusion criteria. Age, prostate weight, pre-operative prostate-spesific antigen (PSA) value, pre-operative gleason score, operation type, post-operative gleason score, International Society for Urological Pathology (ISUP) grade, TNM stage, pathological finding (such as surgical margins and extraprostatic extension) data of the patients were collected retrospectively. Post-operative 12-month follow-up of the patients were examined and the number of interventions due to US and the post-operative timing of these procedures were recorded. Statistical analysis of the data was performed with the SPSS for Windows 22.0 package program Results: Operation type was a significant predictor of post-RP US. Patients who underwent Robot-assisted Radical Prostatectomy (RARP) had lower US rates (5,1%) than patients who underwent Retropubic Radical Prostatectomy (RRP)(18,4%) (p<0.001). There were no significant predictors affecting the time of US. Operation type (p=0,003) and stricture development time (p=0,004) were statistically significant predictors of reccurent US. Patients with RARP had lower reccurrent US rates (9,1%) than patients with RRP(42,9%). Also the rate of recurrent urethral stricture was higher in patients with earlier urethral stricture than patients with later urethral stricture groups (54,1% vs. 37,1% and 14,3%). Conclusions: Our outcomes suggest that the type of operation is an important factor for the development of US after RP. In addition, operation type and time of stricture development were determined as important risk factors for recurrent strictures. Keywords: Prostate cancer, radical prostatectomy, urethral strictures