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SUFU 2020: Triamcinolone Acetonide Injections for the Treatment of Recalcitrant Post-Radical Prostatectomy Vesicourethral Anastomotic Stenosis – A Large Modern-Day Series

Scottsdale, AZ (UroToday.com)  Dr. Humberto Vigil addresses the difficulty of treating vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy (RP). The incidence is reported to be upwards of 29%. VUAS can be challenging for patients as they are susceptible to urinary tract infection, urinary retention, dysuria, incontinence and overall decreasing their quality of life.  Many different treatment options exist. Dr. Vigil and his team sought to “evaluate this excess bladder neck injections of triamcinolone at the time of transurethral incision for prevention of recurrent/recalcitrant post RP-VUAS.

In their study, they had 18 men who are treated with the injections for a total of 25 treatments. They evaluated the resolution as the primary outcome at the follow-up cystoscopy without the need for any more treatment. The graph below shows the total failed treatment in the past.

SUFU 2020 failed treatments

The procedure is as follows:

  1. Bladder neck incision is at 12, nine, 3 o’clock until soft tissue and bleeding is encountered
  2. 40 mg/mL vial of triamcinolone diluted 4 mg/mL with normal saline
  3. Inject into incision site
They found that 15/18 (83.3%) had a successful injection an average follow-up of 16.3 months. Six patients had successful incontinence surgery following steroid treatment. Five pages of complications of urinary retention, gross hematuria, pain, urine extravasation, urinary tract infections (UTI). He concludes that “triamcinolone injections are a safe alternative for recurrent and recalcitrant VUAS. Surgery for urinary incontinence can be done after treatment, with success.”

Presented by: Humberto Vigil, MD, MSc, BSc, FRCSC1

Co-Authors: Sarah Ferrara, MD, BScH, FRCSC,1, Jennifer Locke, MD, PhD, FRCSC,1, Sender Herschorn, MDCM, FRCSC1

1. University of Toronto, Sunnybrook Health Sciences Centre, Dept Urology, Toronto, ON, Canada 

Written by: Lira Chowdhury, DO, Urology Specialist, Urology Partners of North Texas, PLLC, Fort Worth, Texas at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona