ABSTRACT Background and Objective Vesicourethral anastomotic stenosis and/or urethral stenosis (VUAS/US) is a complication of robotic‐assisted radical prostatectomy (RARP) for prostate cancer. We aimed to evaluate the incidence of VUAS/US after RARP and to identify potential risk factors. Materials and Methods We performed a retrospective assessment of clinical records of patients with RARP as primary prostate cancer treatment (January 2011–December 2018) and investigated associations between VUAS/US formation and radiotherapy, pT‐stage, tumor margins, Gleason score, nerve‐sparing, and postoperative duration of bladder catheterization. Statistical analysis was performed via uni‐ and multivariable cox regression; risk estimation was done with the Kaplan–Meier method and log‐rank test. Results and Limitations 809 patients were included in the study. Median clinical follow‐up was 61.0 months (IQR 50.0–75.0) and 175 (22%) patients received radiotherapy. VUAS and US were recorded in 19 (2.3%) and 10 (1.2%) patients, respectively. Whereas in univariable analysis radiotherapy, pT‐stage ≥ pT3a, higher Gleason score, positive tumor margins, nerve‐sparing, and prolonged duration of bladder catheterization were significant risk factors, in a multivariable analysis only radiotherapy ( p = 0.003) and prolonged duration of bladder catheterization ( p = 0.0309) proved to be independently predictive. Estimated 5‐year risk of VUAS/US formation was lower without than with radiotherapy (2.1% 95% CI: 0.9–3.3 vs. 7.3% 95% CI: 3.4–11) and with normal compared to prolonged bladder catheterization (2.6% 95% CI: 1.4–3.8 vs. 9.9% 95% CI: 2.3–18). Retrospectivity and the limited number of events were our major limitations. Conclusions and Clinical Implications Low incidence of VUAS/US in RARP. Patients undergoing radiotherapy or requiring prolonged catheterization should be explicitly informed about the risk of VUAS/US and about symptoms. Also, physicians must be aware.
Massouh et al. (2026) studied this question.