The impact of urinary drainage on the development of anastomotic stricture after radical retropubic prostatectomy

OBJECTIVES: Anastomotic stricture (AS) is a well-described complication of radical retropubic prostatectomy (RRP) despite all the refinements in surgical technique. We aimed to define and discuss the role of postoperative urinary drainage on AS development. PATIENTS AND METHODS: A total of 136 patients with localized prostate carcinoma underwent RRP. In all patients, urethral catheter was removed 3 weeks after RRP without a cystogram. We documented duration of drainage (<3 days, n = 86; 3-5 days, n = 36; and >5 days, n = 14), volume of drainage (<300 ml, n = 78; 300-500 ml, n = 27; and >500 ml, n = 31), and mean volume of drainage per day (<100 ml, n = 85 and >100 ml, n = 51), continence status, and clinical and histopathological characteristics of patients as risk factors related with AS. RESULTS: AS was diagnosed in 28.6% of patients. The rate was found to be 35.9%, 41%, and 23.1%, consistent with duration, and 38.4%, 15.4%, and 46.2% according to volume of drainage, respectively (P = 0.0001). AS occurred in 43.6% and 56.4% of patients concerning mean volume of drainage per day, respectively (P = 0.007). Analysis showed that AS was significantly associated with duration (>3 days), total volume (>500 ml), and the mean volume (>100 ml) of urinary drainage among the variables. The rates of urinary incontinence were 30.7% in patients with AS and 6.2% in patients without AS. CONCLUSIONS: Time and the amount of urinary drainage were significantly associated with stricture formation following RRP that might be caused by partial disruption of the anastomosis.