Contemporary Outcomes after Transurethral Procedures for Bladder Neck Contracture Following Endoscopic Treatment of Benign Prostatic Hyperplasia

Abstract

Objectives: Bladder neck contracture (BNC) is a bothersome complication following endoscopic treatment for benign prostatic hyperplasia (BPH). The objective of our study was to give a more realistic insight into contemporary endoscopic BNC treatment and to evaluate and identify risk factors associated with inferior outcome. Material and Methods: We identified patients who underwent transurethral treatment for BNC secondary to previous endoscopic therapy for BPH between March 2009 and October 2016. Patients with vesico-urethral anastomotic stenosis after radical prostatectomy were excluded. Digital charts were reviewed for re-admissions and re-visits at our institutions and patients were contacted personally for follow-up. Our non-validated questionnaire assessed previous urologic therapies (including radiotherapy, endoscopic, and open surgery), time to eventual further therapy in case of BNC recurrence, and the modality of recurrence management. Results: Of 60 patients, 49 (82%) and 11 (18%) underwent transurethral bladder neck resection and incision, respectively. Initial BPH therapy was transurethral resection of the prostate (TURP) in 54 (90%) and holmium laser enucleation of the prostate (HoLEP) in six (10%) patients. Median time from prior therapy was 8.5 (IQR 5.3–14) months and differed significantly in those with (6.5 months; IQR 4–10) and those without BNC recurrence (10 months; IQR 6–20; p = 0.046). Thirty-three patients (55%) underwent initial endoscopic treatment, and 27 (45%) repeated endoscopic treatment for BNC. In initially-treated patients, time since BPH surgery differed significantly between those with a recurrence (median 7.5 months; IQR 6–9) compared to those treated successfully (median 12 months; IQR 9–25; p = 0.01). In patients with repeated treatment, median time from prior BNC therapy did not differ between those with (4.5 months; IQR 2–12) and those without a recurrence (6 months; IQR 6–10; p = 0.6). Overall, BNC treatment was successful in 32 patients (53%). The observed success rate of BNC treatment was significantly higher after HoLEP compared to TURP (100% vs. 48%; p = 0.026). Type of BNC treatment, number of BNC treatment, and age at surgery did not influence the outcome. Conclusions: A longer time interval between previous BPH therapy and subsequent BNC incidence seems to favorably affect treatment success of endoscopic BNC treatment, and transurethral resection and incision appear equally effective. Granted the relatively small sample size, BNC treatment success seems to be higher after HoLEP compared to TURP, which warrants validation in larger cohorts.

Persistent storage symptoms following Y‐V plasty reconstruction for the treatment of refractory bladder neck contracture

“…19 Despite the available endoscopic treatment options, some patients still experience recurrence. 20 Similar to previous studies on bladder neck reconstruction, 9,10,21 this study shows that these patients can be treated successfully with Y-V plasty reconstruction of the bladder neck with 100% success rate at a median follow-up of 14.8 months. This study demonstrated significant improvements in voiding function, PRO and quality of life (QoL) following bladder neck reconstruction.…”

“…However, reports of serious complications including osteitis pubis and rectourethral fistula or bladder neck necrosis in 7% of patients in a multi‐centre study have steered some surgeons and patients away from this treatment option 19 . Despite the available endoscopic treatment options, some patients still experience recurrence 20 . Similar to previous studies on bladder neck reconstruction, 9,10,21 this study shows that these patients can be treated successfully with Y‐V plasty reconstruction of the bladder neck with 100% success rate at a median follow‐up of 14.8 months.…”

Transurethral Incision of the Bladder Neck at Three Points with a Needle-Type Electrode for Bladder Neck Contracture

“…Ramirez et al reported a success rate of 72% at a mean follow-up of 12.9 months after Collings knife (the same as the needle-type electrode) incision of BNC at 3 and 9 O’clock positions, an overall success rate of 86% after two procedures ( 21 ). Rosenbaum et al showed that the success rate after TUIBN at 4, 8, and 12 O’clock positions was 45%, and the risk factors associated with recurrent BNC were >10 pack/year history of smoking and patients who had undergone more than two previous TUIBN procedures ( 22 ). In the present study, the incision of BNC was carried out at 5, 7, and 12 O’clock positions, resulting in 48 (90.6%) successful cases.…”

Efficacy and safety of bovhyaluronidase azoximer in patients undergoing transurethral resection of the prostate

“…Ранее было показано, что препараты БА благоприятно модифицируют соотношение различных субпопуляций лейкоцитов и цитокиновый профиль крови у пациентов с ДГПЖ и хроническим простатитом [17]. Это особенно важно, если учесть, что сосуществующий с ДГПЖ простатит является установленным фактором риска обструктивных осложнений после ТУРП [9,18].…”