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POD-01.05: Radical Prostatectomy and Sphincter Damage. What Can We Learn from the Pitfalls?

POD-01.05: Radical Prostatectomy and Sphincter Damage. What Can We Learn from the Pitfalls? <h5>Introduction and Objective</h5> Urinary incontinence secondary to a surgical lesion of the external urethral sphincter is a rare complication after RP. Representing the only center in Germany for sphincter repair by tissue engineering patients from 45 different urological clinics in Germany underwent treatment at our institution from 2005 to October 2007. All patients were suffering from urinary incontinence grade III after RP.</P><h5>Materials and Methods</h5> 162 patients with sphincter damage caused by RP were enrolledaccording to the following inclusion criteria: - Stress urinary incontinence grade III - Residual free bladder emptying - Duration of incontinence > 12 months - Refractory incontinence Diagnosis was established by PAD test, urethrocystomanometry and urethrocystoscopy.</P><h5>Results</h5> The mean age of the patients was 70 years (range:56-81). Duration of incontinence was 60 months (range: 12-121). 70% of the patients had been treated by retropubic RP, 22% by laparoscopic RP and 8% by perineal RP previously. All patients had a lesion of the external sphincter, which was documented by endoscopy. In 94/162 (58%), the defect was caused by penetration of the muscle with anastomosis suture. In 127/162 (79%) of the cases there was a direct sphincter lesion in the sense of transsection. In 143/162 (88%) the defect was localized in the lower and in 19/162 (12%) in the upper circumference. An additional relevant concomitant stricture of the anastomosis was seen in 49/162 (30%) Incision of the stricture was realized by urethrotomy following Sachse-technique. The majority of sphincter defects were located close to the dorsal sutures. We recommend the use of special needles (e.g. 27,0 mm 5/8c UR- 6) to avoid sphincter penetration while suturing. Furthermore patients with decreased urinary flow after removal of the catheter are suspicious for penetration of the sphincter. In these patients endoscopic removal of the suture within one month after RP is mandatory.</P><h5>Conclusions</h5> Prevention of sphincter penetration as well as early detection of sphincter penetration may decrease postoperative continence alterations after Radical prostatectomy.</P> http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Urology Elsevier

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