Patient-reported Outcomes of Transperineal Reanastomosis for Recurrent or Obliterative Post-prostatectomy Vesicourethral Anastomotic Stenosis.

PURPOSE: Post-prostatectomy vesicourethral anastomotic stenosis (VUAS) affects up to 5% of patients. A subset of cases remains refractory to endoscopic treatment, significantly impacting quality of life in the long-term. This study presents 15-year follow-up data on patients undergoing open reanastomosis for refractory or obliterative VUAS. PATIENTS AND METHODS: We included patients who underwent transperineal vesicourethral reanastomosis from 2009-2023. The procedure was often staged, with artificial urinary sphincter (AUS) implantation three months later. Co-primary endpoints included retreatment-free survival (RFS) and patient-reported outcome measures (PROMs). RFS was analyzed with Kaplan-Meier estimators, and PROMs were evaluated per scoring manuals. Additionally, we conducted a scoping review of all studies reporting outcomes following complex VUAS reconstruction. RESULTS: Among 46 patients with VUAS, prior endoscopic interventions included dilation (17%), incision (61%), and resection (80%). Median time from prostatectomy to reanastomosis was 23 months (IQR 16-42). At a median follow-up of 80 months (IQR 41-149), RFS rates were 91% at two years and 88% at five years. 30 patients (65%) required staged AUS implantation for stress urinary incontinence. PROMs, assessed in 28 patients (61%), indicated restored voiding function, absence of fecal incontinence, high treatment satisfaction, and low decision regret. Limitations include the absence of preoperative PROMs for baseline comparisons. The scoping review revealed varying success rates ranging from 60% to 92% and a significant underuse of validated PROMs. CONCLUSIONS: Transperineal reanastomosis offers an effective and lasting solution for treating recurrent or obliterative VUAS, with encouraging long-term results and favorable patient-reported outcomes, underscoring its critical role in salvage posterior urethral reconstruction after prostatectomy.