Vesico-uretral anatostomosis stenosis (VUAS) occurs in 1-5% of cases after radical prostatectomy. Standard management begins with endoscopic treatment. If ineffective, surgical reconstruction is usually proposed with success rates being generally high, reaching 80-90%.
However, several studies suggest that a history of pelvic radiotherapy is a risk factor of failure of the surgical treatment and complications.
The aim of our study was to compare the outcomes of surgical repair for VUAS in radiated vs non radiated patients.

The charts of all consecutive patients who underwent robotic VUAS repair after
prostatectomy and/or radiotherapy at four academic centers were
retrospectively reviewed.
Patients undergoing reconstruction for bladder neck stricture/contracture after non-oncologic
surgery were excluded. The study population was divided into two groups: patients with a
history of pelvic radiotherapy and those without.

Thirty-five patients from four academic centers were included in the analysis : 13 in the
non radiated group, and the 22 in the radiated group. The baseline characteristics were similar between groups, although two patients in the radiated group had not undergone any prior endoscopic treatment.

The mean operative time did not differ significantly between the two groups (180 min vs
228 min ; p = 0.26) nor did the estimated blood loss (128 cc vs 302 cc ; p = 0.07). The rate
of early complication was higher in the radiated group but not difference was not
statistically significant (38.46% vs 54.54% ; p = 0.48). Re-operation rate, whether
before or after 30 post-operative days, were also similar between the two groups (7.69%
vs 9.09% ; p = 0.99 before 30 days – 30.76% vs 36.36% ; p = 0.71 after 30 days). The
rate of infectious symphysitis and secondary urinary diversion were respectively three and
two-folds higher in the radiated group, although these differences were not statistically
significant (15.38% vs 45.45% ; p = 0.13 for symphysitis -– 15.38% vs 31.81% ; p = 0.43
for urinary diversion). No statistically significant difference was observed regarding stenosis recurrence (30.76% vs 22.72% ; p = 0.69).

Although no statistically significant difference was observed, the perioperative morbidity appear clearly higher in radiated vs non radiated patients after robotic VUAS repair with almost one third of patient ultimately requiring secondary urinary diversion. This study warrants caution and clear patients’ information when offering robotic VUAS repair to radiated patients.