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Elsherif E, Salman B, Abozaid M, Badawy A. Evaluation of perioperative risk factors for bladder neck contracture after bipolar transurethral resection of the prostate. Int Urol Nephrol 2024:10.1007/s11255-024-04125-2. [PMID: 38958852 DOI: 10.1007/s11255-024-04125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Bladder neck contracture after transurethral resection of the prostate is a common complication but without clear predisposing factors. In this prospective study, we evaluated the perioperative risk factors associated with bladder neck contracture after bipolar transurethral resection of the prostate. METHODS The study included 391 patients who were admitted for bipolar transurethral resection of the prostate between October 2020 to October 2023 by three experienced surgeons. Forty three patients had bladder neck contracture and their perioperative parameters were compared with randomly chosen 172 patients without bladder neck contracture. RESULTS There were no significant differences between the studied groups regarding the general and present history characteristics. Re-catheterization after transurethral resection of the prostate, post-operative recurrent urinary tract infection, resection speed, and associated urethral stricture were significantly higher among the bladder neck-contraction group (P < 0.05), while total PSA, total prostate weight, post void residual urine volume, resected gland weight, resection time and catheter duration were significantly lower among the bladder neck-contraction group (P < 0.05). CONCLUSION Bladder neck contracture after bipolar transurethral resection of the prostate is more common among patients with small fibrotic prostate, low total PSA, small post- void residual urine volume, those with a higher incidence of post-operative recurrent urinary-tract infection and patients with a higher incidence of re-catheterization after transurethral resection of the prostate.
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Affiliation(s)
- Eid Elsherif
- Urology Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, 32511, Menoufia Governorate, Egypt
| | - Baher Salman
- Urology Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, 32511, Menoufia Governorate, Egypt.
| | - Mohammed Abozaid
- Urology Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, 32511, Menoufia Governorate, Egypt
| | - Atef Badawy
- Urology Department, Faculty of Medicine, Menoufia University, Shebin Elkoom, 32511, Menoufia Governorate, Egypt
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2
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Palminteri E, Morselli S, Cindolo L, Rabito S, Toso S, Gatti L, Ferrari R, Micali S, Ferrari G. Iatrogenic or recurrent bladder neck contracture treated by the Palminteri-Ferrari technique: a new way to approach a frustrating condition. World J Urol 2024; 42:195. [PMID: 38530433 DOI: 10.1007/s00345-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Bladder neck stricture (BNS) is a bothersome disease which may affect patients after trauma or prostatic surgery. It is frustrating due to the low durable success rate of currently available surgical techniques. The aim of the study is to explore the efficacy of a novel technique. MATERIALS & METHODS The surgical protocol was developed by two high case-volume surgeons. The technique consists of Holmium laser incisions at 3-6-9-12 o'clock. Subsequently, triamcinolone acetonide 40 mg is injected. Two months later, the BNS is endoscopically checked in operatory room and re-procedure take place, if necessary (max 3 times). Failure was defined as the need of definitive urinary diversion. Subjective satisfaction was measured through PGI-I Questionnaire. RESULTS A total of 45 patients were enrolled. Median age was 63 (IQR 59-69) years and BNS developed by different causes. Naïve BNS procedure patients were 12 (26.7%), others 33 (73.3%) underwent median 2 (IQR 1-4) previous urethrotomies, including 16 other surgeries. Suprapubic bladder catheter was present in 34 patients (75.6%). No complications were registered. Re-procedure at control was necessary in 24 patients (53.3%) for a median of 1 (IQR 1-3) procedures. At median follow-up of 18 months, failures were 4 (8.9%) and urinary incontinence was reported in 2 patients (4.5%) who required incontinence surgery. Median PGI-I was 2. CONCLUSIONS Our technique of BNS treatment allows good outcomes and high rate of subjective improvement amongst patients. Moreover, naïve patients seem to have better results. However, longer follow-up and higher sample size are mandatory to further assess these data.
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Affiliation(s)
- Enzo Palminteri
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
| | - Simone Morselli
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy.
| | - Luca Cindolo
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
| | - Salvatore Rabito
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
| | - Stefano Toso
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
| | - Lorenzo Gatti
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, C.Ur.E., Centro Urologico Europeo, Hesperia Hospital, Via Arquà 80, Modena, Italy
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Bhatt R, Mittauer DJ, Vetter JM, Barashi NS, McGinnis R, Sands KG, Chow AK, Kim EH. Comparing Bladder Neck Contracture Rate Between Robotic Intracorporeal and Extracorporeal Neobladder Construction. Cureus 2024; 16:e56825. [PMID: 38659512 PMCID: PMC11040430 DOI: 10.7759/cureus.56825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Robot-assisted radical cystectomy (RARC) has become more accessible to surgeons worldwide, and descriptions of intracorporeal urinary diversion techniques, such as orthotopic neobladder construction, have increased. In this study, we aim to compare the rate of bladder neck contracture (BNC) formation between RARC and two different urinary diversion techniques. We retrospectively reviewed our institutional database for patients with bladder cancer who underwent RARC with intracorporeal neobladder (ICNB) construction (n = 11) or extracorporeal neobladder (ECNB) construction (n = 11) between 2012 and 2020. BNC was defined by the need for an additional surgical procedure (e.g., dilatation, urethrotomy). Patients who underwent RARC with ICNB (n = 11) were compared to patients who underwent RARC with ECNB (n = 11) across patient characteristics and postoperative BNC formation rates. Kaplan-Meier curves were generated for freedom from BNC based on the neobladder approach and compared with the log-rank test. For patients who received an ECNB, 73% (8/11) developed a BNC; in comparison, none of the patients in the ICNB group experienced a BNC. Kaplan-Meier survival analysis demonstrates the ECNB group's median probability of freedom from BNC as 1.3 years, while the ICNB group was free of BNC over the study period (p < 0.001). RARC with ICNB creation demonstrated a significantly reduced BNC rate in contrast to RARC with ECNB construction. Longer-term follow-up is needed to assess the durability of this difference in BNC rates.
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Affiliation(s)
- Rohit Bhatt
- Department of Urology, University of California Irvine Health, Orange, USA
| | - Dylan J Mittauer
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Joel M Vetter
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Nimrod S Barashi
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Riley McGinnis
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Kenneth G Sands
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Alexander K Chow
- Department of Urology, Rush University Medical Center, Chicago, USA
| | - Eric H Kim
- Department of Urology, Washington University School of Medicine, St. Louis, USA
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Syarif S, Azis A, Patimura MIF, Putra MZDA, Nusraya A, Natsir AS. Giant stone in a urinary bladder diverticulum in a 69-year-old male: a case report. Pan Afr Med J 2023; 45:181. [PMID: 38020350 PMCID: PMC10656586 DOI: 10.11604/pamj.2023.45.181.38723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/30/2023] [Indexed: 12/01/2023] Open
Abstract
The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications.
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Affiliation(s)
- Syarif Syarif
- Department of Surgery, Faculty of Medicine Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Abdul Azis
- Department of Surgery, Faculty of Medicine Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | | | | | - Ade Nusraya
- General Practicioner, Siloam Hospital, Makassar, South Sulawesi, Indonesia
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5
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Kunkel G, Patel H, Kaldany A, Allu S, Elsamra S, Cancian M. Pelvic radiation-induced urinary strictures: etiology and management of a challenging disease. World J Urol 2023; 41:1459-1468. [PMID: 37014391 DOI: 10.1007/s00345-023-04378-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Radiation is a common treatment modality for pelvic malignancies. While it can be effective at cancer control, downstream effects can manifest months to years after treatment, leaving patients with significant morbidity. Within urology, a particularly difficult post-radiation consequence is urinary tract stricture, either of the urethra, bladder neck, or ureter. In this review, we will discuss the mechanism of radiation damage and treatment options for these potentially devastating urinary sequelae.
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Affiliation(s)
- Gregory Kunkel
- Department of Urology, UMass Chan: University of Massachusetts Medical School, Worcester, MA, USA.
| | - Hiren Patel
- Division of Urology, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alain Kaldany
- Division of Urology, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sai Allu
- Division of Urology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sammy Elsamra
- Division of Urology, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Madeline Cancian
- Division of Urology, Brown University Warren Alpert Medical School, Providence, RI, USA
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Capibaribe DM, Avilez ND, Sacomani CAR, Lucena ASPDN, Reis LO. Robotic approach to vesicourethral anastomotic stenosis and resection of remaining prostate after radical prostatectomy. Int Braz J Urol 2022; 49:158-160. [PMID: 36037257 PMCID: PMC9881810 DOI: 10.1590/s1677-5538.ibju.2022.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To show a total transabdominal robotic approach to an extensive recalcitrant vesicourethral anastomotic stenosis (VUAS) after open radical prostatectomy (ORP) with end-to-end anastomosis. While there is very little literature on the matter and even fewer videos showing the actual surgical view with a step-by-step explanation in complex cases, VUAS robotic transabdominal surgery provides better view and reach, with potentially better continence results, without the need for pubectomy. METHODS A 72-year-old male was submitted to a failed ORP for Gleason 3+4 localized cancer 2 years before, where the wrong plane of dissection left behind prostate remnants and the seminal vesicles, which evolved with a complex stenosis and recurrent episodes of acute urinary retention (AUR) that started two weeks after the first catheter removal. Five endoscopic procedures in total were unsuccessful and AUR reoccurred. A vesico-urethral cystography (VUC) and multiparametric prostate and urethral MRI found the seminal vesicles with prostate remnants, two centimeters urethral stenosis from bladder neck to bulbar urethra and periurethral fibrosis with no evidence of residual tumor. PSA was 1.2 and prostate biopsy showed no tumor on prostate remnant. A transabdominal robotic approach was chosen. RESULTS Prostate residue, bladder neck and periurethral fibrosis were excised, with healthy mucosa found on both ends. End-to-end anastomosis was successful. Drain and catheter were removed on the 1st and 14th post-operative day, respectively, with good urinary stream. A VUC at 30 days showed a patent bladder neck. Incontinence was 3 pads/day after catheter removal and decreased to 1 pad/day after 180 days. CONCLUSION VUAS may reach 15% (1, 2) and endourologic therapies are first-line choices, however, recalcitrant cases require reconstruction (3-6). The most common approach is perineal, with high incontinence rates, reaching >90% (7, 8). The retropubic alternative has better but also discouraging numbers of up to 58% incontinence rates (9). Though with 100% social continence results, the 2021 European guidelines still could not recommend the robotic procedure as standard of care due to evidence limited to anecdotal reports (10-12).
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Affiliation(s)
- Diego Moreira Capibaribe
- Universidade Estadual de Campinas - UNICAMPFaculdade de Ciências Médicas daUroScienceCampinasSPBrasilUroScience, Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP - Campinas, SP, Brasil
| | - Natália Dalsenter Avilez
- Universidade Estadual de Campinas - UNICAMPFaculdade de Ciências Médicas daUroScienceCampinasSPBrasilUroScience, Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP - Campinas, SP, Brasil
| | | | | | - Leonardo Oliveira Reis
- Universidade Estadual de Campinas - UNICAMPFaculdade de Ciências Médicas daUroScienceCampinasSPBrasilUroScience, Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP - Campinas, SP, Brasil,Pontifícia Universidade Católica de Campinas - PUCCampinasSPBrasilPontifícia Universidade Católica de Campinas - PUC -Campinas, - Campinas, SP, Brasil,Correspondence address:
Leonardo Oliveira Reis, MD, MSc, PhD, UroScience, Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP, R. John Boyd Dunlop, s/n Campinas, SP,
13060-904
, Brasil. E-mail:
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7
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Shaw NM, Marhamati S, Friedman A, Sussman R, Venkatesan K. Recurrent vesicourethral anastomotic stenosis following treatment for prostate cancer: an effective endoscopic treatment using bipolar plasma button and triamcinolone. Int Urol Nephrol 2022; 54:1001-1008. [PMID: 35235110 DOI: 10.1007/s11255-022-03153-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the efficacy of deep bladder neck incision plus adjuvant Triamcinolone in the treatment of recurrent vesicourethral anastomotic stenosis following surgical treatment for prostate cancer. MATERIALS AND METHODS A retrospective review of patients undergoing bladder neck incision from 2013 to 2019 was conducted. Patients who had previously undergone surgical treatment for prostate cancer and had failed treatment for bladder neck contracture were included. RESULTS Twenty patients underwent deep bladder neck incision (BNI) with plasma button and adjuvant injection with a patency rate of 85%. Complete obliteration portended worst prognosis with 100% recurrence. CONCLUSIONS Deep BNI with triamcinolone is a minimally morbid alternative for treatment of refractory vesicourethral anastomotic contractures.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, MedStar Georgetown, Washington, DC, USA
| | - Shawn Marhamati
- Department of Urology, MedStar Georgetown, Washington, DC, USA
| | | | - Rachael Sussman
- Department of Urology, MedStar Georgetown, Washington, DC, USA
| | - Krishnan Venkatesan
- Department of Urology, MedStar Georgetown, Washington, DC, USA. .,Department of Urology, MedStar Washington Hospital Center, 110 Irving St POB 3rd Floor, Washington, DC, 20010, USA.
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8
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Obiora D, Yang H, Gor RA. Robotic assisted reconstruction for complications following urologic oncologic procedures. Transl Androl Urol 2021; 10:2272-2279. [PMID: 34159109 PMCID: PMC8185667 DOI: 10.21037/tau.2020.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite technical refinements in urologic oncologic surgery, complications are inevitable and often carry significant morbidity. Similar to oncologic surgery, reconstructive surgery has realized a paradigm shift from mainly open to an increasingly minimally invasive approach. Robotic assisted surgery has facilitated this transition as it mitigates some of the limitations of traditional laparoscopy. With continued technological advances in robotic technology along with improved training and experience, the breadth and complexity of cases expand annually. Few head to head trials exist and data is overall heterogeneous. Herein, we review and summarize the currently available literature describing robotic assisted reconstruction for complications following urologic oncologic procedures.
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Affiliation(s)
- Daisy Obiora
- Division of Urology, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Hailiu Yang
- Division of Urology, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ronak A Gor
- Division of Urology, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
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Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol 2020; 39:527-532. [PMID: 32367159 DOI: 10.1007/s00345-020-03224-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To present our preliminary experience in managing patients with highly recurrent bladder neck contractures (BNCs) after transurethral resection of the prostate (TURP). METHODS Between February 2015 and March 2018, 28 patients with highly recurrent BNCs who had failed multiple prior to endoscopic treatments were managed with transurethral resection and intra- and post-operative triamcinolone acetonide injections. The scar tissue was resected to the circular fiber at the bladder neck, and triamcinolone acetonide (2 mL, 40 mg/mL) was injected at the incision sites (8 points) using a cystoscopic injection needle. The cystoscopy-guided injections were repeated every four weeks for total three times after surgery. The patients were followed up at 3, 6, 12 months after surgery, and in July-August 2019. RESULTS The recurrent interval before the treatments was 2.2 ± 1.2 months, without any BNC recurrence in the first 12 weeks after transurethral resection. The urinary flow rate increased significantly and was maintained during the follow-up period. Adequate voiding function was reported in 25 of 28 patients at a median follow-up of 2.8 (1.7, 3.9) years. One of the three patients with decreased urinary flow rate had underactive detrusor and no BNC recurrence. The complications were mild and tolerable. CONCLUSION Transurethral resection of the scar tissue combined with intra- and post-operative triamcinolone acetonide injections resulted in a success rate of 92.9% in patients with highly recurrent BNC following TURP. It is a simple, safe, and effective treatment for highly recurrent BNCs.
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10
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Abstract
This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision.
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Affiliation(s)
- James Furr
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, California, USA
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11
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Zhao LC. Management of Urethral Stenosis After Treatment for Prostate Cancer: NYU Case of the Month, August 2020. Rev Urol 2020; 22:133-134. [PMID: 33239974 PMCID: PMC7672505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Lee C Zhao
- Department of Urology, NYU Grossman School of Medicine and NYU Langone Health New York, NY
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12
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Holmium: YAG Laser Incision of Bladder Neck Contracture Following Radical Retropubic Prostatectomy. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.88677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Abstract
Secondary bladder neck sclerosis represents one of the more frequent complications following endoscopic, open, and other forms of minimally invasive prostate surgery. Therapeutic decisions depend on the type of previous intervention (e.g., radical prostatectomy, TURP, HoLEP, radiotherapy, HIFU) and on associated complications (e.g., incontinence, fistula). Primary treatment in most cases represents an endoscopic bilateral incision. No specific advantages of any type of the applied energy (i.e., mono-/bipolar HF current, cold incision, holmium/thulium YAG laser) could be documented. Adjuvant measures such as injection of corticosteroids or mitomycin C have not been helpful in clinical routine. In case of first recurrence, a transurethral monopolar or bipolar resection can usually be performed. Recently, the ablation of the scared tissue using bipolar vaporization has been recommended providing slightly better long-term results. Thereafter, surgical reconstruction is strongly recommended using an open, laparoscopic, or robot-assisted approach. Depending on the extent of the bladder neck sclerosis and the underlying prostate surgery, a Y-V/T-plasty, urethral reanastomosis, or even a radical prostatectomy with new urethravesical anastomosis should be performed. Stent implantation should be reserved for patients who are not suitable for surgery. The final palliative measure is a cystectomy with urinary diversion or a (continent) cystostomy.
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14
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Baker N, Tong C, Simhan J. Reconstructive Management Options of Delayed Complications Following Bladder Outlet Surgery. Curr Urol Rep 2017; 18:27. [PMID: 28247326 DOI: 10.1007/s11934-017-0678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Technological advancements in urologic endoscopy within the last decades have improved outcomes following bladder outlet reduction surgery while minimizing risks of short- and intermediate-term complications. This review aims to examine late complications of endoscopic reduction of the prostate and the various treatment options available. RECENT FINDINGS Urinary incontinence, ejaculatory dysfunction, urethral strictures, bladder neck contractures, and fistula formations are the most common delayed complications following bladder outlet reduction surgery. Evaluation of these complications typically involves a combination of endoscopic examination, urodynamic findings, pelvic imaging, and review of pre-existing symptoms. Treatment options range from conservative measures such as pelvic floor muscle therapy to complex reconstructive procedures including anti-incontinence surgery, urethral reconstruction, and permanent urinary diversion. Although rare, late complications of bladder outlet reduction surgery are important to recognize in order to manage appropriately. Careful evaluation involving multiple diagnostic modalities with consideration for referral to a dedicated reconstructive urologist may be warranted in complex cases.
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Affiliation(s)
- Nora Baker
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Carmen Tong
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA. .,Urologic Trauma, Reconstruction and Prosthetics, Einstein Healthcare Network, Temple Health and the Fox Chase Cancer Center, 1200 Tabor Road, Moss/3 Sley, Philadelphia, PA, 19141, USA.
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