Bladder Neck Contracture as a Complication of Prostate Surgery

Abstract

Bladder neck contracture (BNC) is one of the most common complications of surgical treatment of prostate diseases. The rate of postoperative BNC varies depending on the type of surgical treatment used. The options for treatment techniques for BNC can vary from endoscopic interventions to complex (abdominal) surgical interventions. This review evaluates various alternative surgical methods of BNC treatment. The search and analysis of publications in the databases PubMed (MEDLINE), Scopus, Cochrane Library, according to the keywords, “bladder neck sclerosis,” “benign prostatic hyperplasia,” “BNC,” “bladder neck stenosis,” “balloon dilation,” “treatment.” As a result, 71 publications were selected and included in this review. In addition to the standard treatment methods in the form of transurethral resection and incision of the bladder neck using electricity and laser energy, the urologist also has alternative methods of treatment, such as balloon dilation, placement of urethral stents, instillation of the bladder or intraoperative injection of cytostatic drugs, hormones, hyaluronic acid derivatives, and biomedical cell products into the bladder neck area. Although transurethral resection is currently the main treatment option for BNC, the recurrence rate after this procedure can reach up to 38%. According to the literature, balloon dilation can be a promising and minimally invasive method of treatment for recurrent BNC. This method can be used as the first stage in the treatment of recurrent contracture deformity. Furthermore, intravesical instillation of various anti-inflammatory drugs and cytostatics can be promising directions in the treatment and prevention of BNC.

Refractory Bladder Neck Contracture (BNC) After Radical Prostatectomy: Prevalence, Impact and Management Challenges

“…In terms of continence, this can be challenging, as apart from the risk of sphincter injury, it can also unmask an already incompetent sphincter which has been compensated by the scarring. 12,85 It is thus important to perform a thorough pre-operative work up in order to determine the length of obliteration and involvement of the membranous urethra/ external sphincter so as to appropriately counsel patients regarding the need for additional incontinence surgery. Comparisons between the different surgical reconstructive techniques are summarised in Table 2.…”

“…This is the preferred option if the tissue is malleable. 12,85,96 However, if the defect is larger than expected and the primary anastomosis would be under tension then the gap can be bridged with variety of autologous grafts, flaps or augmentation techniques.…”

Ultrasound-Triggerable Coatings for Foley Catheter Balloons for Local Release of Anti-Inflammatory Drugs during Bladder Neck Dilation

“…The options for treatment techniques can vary from simple, office-based dilation procedures ( Figure 1 A) to more-invasive, complex abdominoperineal reconstructive surgery [ 1 , 3 ]. Transurethral resection is currently the main treatment option for BNC, but the recurrence rate after this procedure can reach up to 38% [ 4 ]. At the same time, balloon dilation [ 4 , 5 ] and self-dilation [ 6 ] can be promising and minimally invasive alternatives for the treatment of recurrent BNC [ 4 , 7 , 8 , 9 ].…”

“…Transurethral resection is currently the main treatment option for BNC, but the recurrence rate after this procedure can reach up to 38% [ 4 ]. At the same time, balloon dilation [ 4 , 5 ] and self-dilation [ 6 ] can be promising and minimally invasive alternatives for the treatment of recurrent BNC [ 4 , 7 , 8 , 9 ]. However, this option is viable only for well-motivated patients because the treatment involves several procedures with an individually selected frequency and requires a great deal of tolerance and compliance [ 1 ].…”