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Enzo P, 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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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)
- Palminteri Enzo
- 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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Viegas V, Freton L, Richard C, Haudebert C, Khene ZE, Hascoet J, Verhoest G, Mathieu R, Vesval Q, Zhao LC, Bensalah K, Peyronnet B. Robotic YV plasty outcomes for bladder neck contracture vs. vesico-urethral anastomotic stricture. World J Urol 2024; 42:172. [PMID: 38506927 DOI: 10.1007/s00345-024-04814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To compare the outcomes of patients undergoing robotic YV plasty for bladder neck contracture (BNC) vs. vesico-urethral anastomotic stricture (VUAS). METHODS A retrospective study included male patients who underwent robotic YV plasty for BNC after endoscopic treatment of BPH or VUAS between August 2019 and March 2023 at a single academic center. The primary assessed was the patency rate at 1 month post-YV plasty and during the last follow-up visit. RESULTS A total of 21 patients were analyzed, comprising 6 in the VUAS group and 15 in the BNC group. Patients with VUAS had significantly longer operative times (277.5 vs. 146.7 min; p = 0.008) and hospital stay (3.2 vs. 1.7 days; p = 0.03). Postoperative complications were more common in the VUAS group (66.7% vs. 26.7%; p = 0.14). All patients resumed spontaneous voiding postoperatively. Five patients (23.8%) who developed de novo stress urinary incontinence had already an AUS (n = 1) or required concomitant AUS implantation (n = 3), all of whom were in the VUAS group (83.3% vs. 0%; p < 0.0001). The proportion of patients improved was similar in both groups (PGII = 1 or 2: 83.3% vs. 80%; p = 0.31). Stricture recurrence occurred in 9.5% of patients in the whole cohort, with no significant difference between the groups (p = 0.50). Long-term reoperation was required in three VUAS patients, showing a statistically significant difference between the groups (p = 0.05). CONCLUSION Robotic YV plasty is feasible for both VUAS and BNC. While functional outcomes and stricture-free survival may be similar for both conditions, the perioperative outcomes were less favorable for VUAS patients.
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Affiliation(s)
- Vanessa Viegas
- Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | | | | | | | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Quentin Vesval
- Department of Urology, University of Rennes, Rennes, France
| | - Lee C Zhao
- Department of Urology, New York University, New York, USA
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
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Wu MH, Liu JX, Zhang YF, Cao ZB, Song HC, Yang BY, Shi MJ, Du Y, Song J, Li XH. Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study. World J Urol 2024; 42:14. [PMID: 38189837 DOI: 10.1007/s00345-023-04715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE Bladder neck contracture (BNC) is a rare but intolerant complication after transurethral surgery of prostate. The present study aims to investigate the incidence and risk factors of BNC in patients diagnosed benign prostate hyperplasia (BPH) and following transurethral resection or enucleation of the prostate (TURP/TUEP). METHODS This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients' demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors. RESULTS A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8 months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8 months, 35% (7/20) of BNC patients recurred at a median time of 1.8 months. CONCLUSION BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.
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Affiliation(s)
- Meng-Hua Wu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jia-Xin Liu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yu-Feng Zhang
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Zi-Bing Cao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Urology, Beijing Miyun District Traditional Chinese Medicine Hospital, Beijing, China
| | - Hong-Chen Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo-Yu Yang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ming-Jun Shi
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuan Du
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xuan-Hao Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Sun J, Xia SQ, Tong Z, Xiao DD, Chen B. Transurethral columnar balloon dilation of the prostate combined with holmium laser incision for bladder neck contracture in day-surgery mode. Lasers Med Sci 2023; 38:279. [PMID: 38030741 DOI: 10.1007/s10103-023-03942-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
The study aimed to investigate the clinical effect of transurethral columnar balloon dilation of the prostate combined with holmium laser in the treatment of bladder neck contracture (BNC). This retrospective study included 41 patients with BNC, who had been treated with transurethral columnar balloon dilation and holmium laser in our hospital from June 2020 to June 2022. Admission, operation, and discharge of all the patients were completed in 24 h. The patients' satisfaction, postoperative complications, and chronic pain after operation were followed up. Clinical parameters, such as International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR) in pre-operation, 1 month and 6 months after operation were recorded. All patients underwent the operations successfully. Six patients experienced urge incontinence and one patient experienced recurrence of BNC after 12 months. At 1 month and 6 months after the operation, IPSS, QoL, PVR, and Qmax of the patients were significantly better than those before the operation (P < 0.05). Transurethral columnar balloon dilation of the prostate combined with holmium laser can effectively treat BNC with simple performance and satisfactory clinical effects. It is a minimally invasive treatment that can be conducted by simple day surgery.
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Affiliation(s)
- Jie Sun
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, No 160, PuJian Road, Pudong New District, Shanghai, 200127, China
| | - Sheng-Qiang Xia
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, No 160, PuJian Road, Pudong New District, Shanghai, 200127, China
| | - Zhen Tong
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, No 160, PuJian Road, Pudong New District, Shanghai, 200127, China
| | - Dong-Dong Xiao
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, No 160, PuJian Road, Pudong New District, Shanghai, 200127, China
| | - Bin Chen
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, No 160, PuJian Road, Pudong New District, Shanghai, 200127, China.
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Pokhrel SM, Sharma A, Singh M. Uttarabasti in bladder neck contracture following transurethral resection of prostate: A case report. J Ayurveda Integr Med 2023; 14:100772. [PMID: 37499589 PMCID: PMC10388190 DOI: 10.1016/j.jaim.2023.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/08/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
Bladder neck contracture is a common complication of the TURP. Traumatic inflictions may lead to the formation of scar tissue around the bladder neck which makes this tubular structure narrower than the normal. It causes urinary flow obstruction associated with pain, heaviness, hesitancy and incomplete bladder emptying. In Ayurveda, such features have been described under the context of Vatakundalika and Mutrotsanga under the chapter 58 named 'Mutraghata Pratishedha Adhyaya'of Uttar Tanta of Sushruta Samhita. Bladder neck resection surgery is considered as the surgical treatment in this case but the recurrence rate is high. In Ayurvedic texts, Uttarabasti has been indicated in the treatment of various urinary disorders. A 70-year-old male patient visited the Outdoor Patient Department (OPD) of hospital of National Institute of Ayurveda (NIA), Jaipur, Rajasthan, India; with chief complaints of difficulty in micturition, pain during micturition along with poor stream of urine for the last 2.5 years. He had past history of surgical intervention of Transurethral resection of prostate (TURP) for prostatomegaly and transurethral incision of bladder neck (TUI-BN) of bladder neck contracture. This was diagnosed as a case of recurrent urinary bladder neck contracture and was managed with Uttarabasti of Bala-Ashwagandhadi Taila and oral Ayurvedic medicines with encouraging results. Ayurveda may prove helpful in such type of recurrent and recalcitrant cases and the intervention of Uttarabasti Karma is specifically indicated for the same.
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Affiliation(s)
- Saroj Mani Pokhrel
- PG Department of Shalya Tantra, National Institute of Ayurveda (deemed to Be University), Jaipur, India.
| | - Aditya Sharma
- PG Department of Shalya Tantra, National Institute of Ayurveda (deemed to Be University), Jaipur, India
| | - Manorma Singh
- PG Department of Shalya Tantra, National Institute of Ayurveda (deemed to Be University), Jaipur, India
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Özveren B, Karşıyakalı N, Türkeri L. Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models. Arab J Urol 2023; 22:31-38. [PMID: 38205384 PMCID: PMC10776077 DOI: 10.1080/2090598x.2023.2222262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/27/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP. Material and Methods A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma. Results The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis. Conclusions An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.
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Affiliation(s)
- Bora Özveren
- Department of Urology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Nejdet Karşıyakalı
- Department of Urology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Chen YH, Li XD, Ke ZB, Chen JY, Lin T, Lin TT, Zhu JM, Zheng QS, Xue XY, Wei Y, Xu N. Risk factors for the postoperative bladder neck contracture in patients with small-volume prostatic hyperplasia. Asian J Surg 2023; 46:373-379. [PMID: 35525691 DOI: 10.1016/j.asjsur.2022.04.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study was to explore the risk factors for postoperative bladder neck contracture (BNC) after transurethral operation of prostate in patients with small-volume prostatic obstruction. METHODS Clinicopathologic data at our center from February 2016 to January 2020 were retrospectively collected and analyzed. Clinicopathological characteristics between patients with and without BNC were compared. Multivariate logistic regression was used to determine the risk factors for postoperative BNC. RESULTS There were a total of 39 patients (8.53%) with postoperative BNC. Multivariate logistic regression analysis demonstrated that preoperative bladder neck diameter (BND), intravesical prostatic protrusion (IPP), surgical methods (transurethral resection of prostate (TURP)/anatomical endoscopic enucleation of the prostate (AEEP)), and postoperative urinary tract infection (UTI) were independent risk factors for postoperative BNC in patients with small-volume prostatic obstruction (P < 0.05). The incidence of postoperative BNC in patients undergoing AEEP was significantly decreased compared with those undergoing TURP. The optimal cut-off value of preoperative IPP was 6.10 mm while the optimal cut-off value of preoperative BND was 2.52 cm. CONCLUSIONS Larger preoperative bladder neck and higher preoperative IPP lead to decreased incidence of postoperative BNC in patients with small-volume prostatic obstruction. Active management of postoperative UTI could effectively prevent the occurrence of postoperative BNC. Compared with TURP, complete AEEP would contribute to reduce BNC in patients with small-volume prostatic obstruction.
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Affiliation(s)
- Ye-Hui Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Xiao-Dong Li
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Zhi-Bin Ke
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Jia-Yin Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Tian Lin
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Ting-Ting Lin
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Jun-Ming Zhu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Qing-Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Xue-Yi Xue
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China; Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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Abbasi B, Shaw NM, Lui JL, Li KD, Sudhakar A, Low P, Hakam N, Nabavizadeh B, Breyer BN. Posterior urethral stenosis: a comparative review of the guidelines. World J Urol 2022; 40:2591-2600. [PMID: 36018366 PMCID: PMC9617833 DOI: 10.1007/s00345-022-04131-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022). METHODS The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines. RESULTS The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA. CONCLUSION The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.
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Affiliation(s)
- Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington DC, USA
| | - Jason L Lui
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Architha Sudhakar
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Patrick Low
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chen BH, Tseng JS, Chiu AW. Bladder Neck Contracture with Hem-o-Lok Clips Migration after Robotic-Assisted Radical Prostatectomy: A Case Report and Literature Review. Urol Int 2022; 106:970-973. [PMID: 34979514 DOI: 10.1159/000521152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022]
Abstract
Hem-o-lok clips are widely used in robotic-assisted radical prostatectomy (RARP). However, clips-related complications have been reported, including intravesical migration. Here, we share a 60-year-old male case with newly diagnosed prostatic adenocarcinoma. With an unfavorable intermediate risk, he was admitted for RARP. He was discharged from hospital without any immediate complications. However, he reported progressive dysuria and slow urine stream 6 months after surgery. Cystoscopy showed severe bladder neck contracture (BNC), and 2 Hem-o-lok clips were found intravesically and removed during bladder neck incision. Subsequently, fiberocystoscopy revealed another 2 clips near the bladder neck with mild BNC after another 6 months. These 2 clips were also removed during bladder neck dilatation. His urination status then improved without further obstruction. Clip migration after RARP is uncommon; however, clinicians must keep this in mind when patients present with new complaints such as lower urinary tract symptoms, hematuria, and recurrent urinary tract infections.
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Affiliation(s)
- Bo-Han Chen
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Allen W Chiu
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Furukawa Y, Maru S, Toyoda Y, Sakuta T, Maeno K, Matsumura K, Koyanagi T. [TREATMENT OUTCOMES OF BLADDER NECK CONTRACTURE AFTER TRANSURETHRAL PROSTATE SURGERY]. Nihon Hinyokika Gakkai Zasshi 2022; 113:90-95. [PMID: 37468278 DOI: 10.5980/jpnjurol.113.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
(Introduction) A known complication of the surgical treatment of benign prostatic hyperplasia (BPH) is bladder neck contracture (BNC). BNC is often treated using transurethral incision of the bladder neck (TUI-BN); however, there are few reports on the outcomes of TUI-BN. Therefore, we examined the outcomes of patients who underwent TUI-BN after transurethral prostate surgery. (Material and methods) We retrospectively examined 25 patients who underwent TUI-BN between February 2015 and January 2021 for the following: (1) patients' characteristics; (2) the time from transurethral prostate surgery to TUI-BN; (3) the trigger of BNC diagnosis; (4) surgical procedure of BNC repair/perioperative course; (5) micturition function immediately after TUI-BN; and (6) Postoperative outcomes. (Results) The median age of the patients was 77 years, and the surgical procedures for BPH were transurethral resection of the prostate (TURP) in four cases, transurethral resection in saline plasma vaporization of the prostate (TURisP) in nine cases, and transurethral enucleation with bipolar (TUEB) in 12 cases. The median time to onset of BNC symptoms was 364 days, and 18 patients (72%) were diagnosed within 2 years. The trigger of BNC diagnosis was urinary symptoms in 21 cases, of which 16 patients had exacerbation of urination. The median duration of the surgical procedure of BNC repair was 14 min, and the incisions most frequently used (in 44% of cases) were at the 4 o'clock and 8 o'clock positions. Transient stress urinary incontinence was observed as a complication in three cases. In the 4 o'clock and 8 o'clock incisions, the maximum urine flow rate improved significantly (11.1 mL/s perioperatively vs. 20.9 mL/s postoperatively; P=0.004). These symptoms improved in 16 of the 21 symptomatic cases, and the maximum urine flow rate improved significantly (P< 0.01). The median observation period after surgery was 170 days; eight postoperative patients were lost to follow up. There were two cases of recurrence. (Conclusions) BNC is likely to develop within 2 years after transurethral prostate surgery. In this study, the success rate of the initial TUI-BN was 92%, as reoperation was required in two cases; however, the overall prognosis was good.
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Abstract
PURPOSE OF REVIEW This article reviews the mechanisms, risk factors, evaluation and current management options for iatrogenic lower urinary tract stenosis, including urethral stricture and bladder neck contracture, caused by surgery for benign prostatic hyperplasia (BPH). RECENT FINDINGS The incidence of iatrogenic stenosis following endoscopic BPH surgery ranges from 0 to 9.7%. New endoscopic techniques and technologies for treating BPH do not appear to substantially mitigate this risk. However, new advances in our understanding of urethral sphincter anatomy combined with both innovative open urethroplasty techniques and utilization of robotic surgery for bladder neck reconstruction, offer promise in improving treatment outcomes for this patient population. Treating patient with stenosis following BPH-related surgery can be challenging, especially in patients with recurrent disease. Optimizing outcomes and patient satisfaction relies on performing a thorough work-up and openly discussing treatment choices, risks and postoperative expectations with patients. Future research and emerging technology in both endoscopic BPH treatment surgical options and management of postoperative stenosis is critical to continuing to improve patient care.
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Bozkurt O, Sen V, Demir O, Esen A. Subtrigonal Inlay Patch Technique with Buccal Mucosa Graft for Recurrent Bladder Neck Contractures. Urol Int 2021; 106:256-260. [PMID: 34610599 DOI: 10.1159/000517894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to present a novel subtrigonal inlay patch (SIP) technique with buccal mucosa graft (BMG) for recurrent bladder neck contracture (BNC) via open approach. MATERIALS AND METHODS Surgical approach for SIP technique is described in detail and outcomes of patients who have been operated with this technique for recurrent BNC were given. Briefly, bladder neck incision is performed after vertical cystotomy, fibrotic scar tissue is excised completely, and a BMG is patched at the end. RESULTS All 3 patients were able to void in their first attempt after catheter removal. Follow-up durations were 14, 11, and 5 months for the patients and all 3 patients reported satisfactory voiding. No de novo urinary incontinence was reported by patients after catheter removal, and all were continent with no pad need on their last follow-up visit. None of the operated patients needed any intervention such as catheterization, dilatation, or internal urethrotomy for BNC on follow-up. CONCLUSION The present study demonstrates the feasibility and promising results of SIP technique with open surgical approach. Further experience is mandatory with larger patient cohorts and longer follow-up.
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Affiliation(s)
- Ozan Bozkurt
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Volkan Sen
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Omer Demir
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Adil Esen
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Chen YZ, Lin WR, Chow YC, Tsai WK, Chen M, Chiu AW. Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate. BMC Urol 2021; 21:59. [PMID: 33840387 PMCID: PMC8037916 DOI: 10.1186/s12894-021-00831-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). METHODS Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. RESULTS Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94-0.99), p = 0.008) and recatherization (OR 5.6 (1.02-30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. CONCLUSION This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.
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Affiliation(s)
- Yi-Zhong Chen
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan.,School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yung-Chiong Chow
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan.,School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan.,School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Marcelo Chen
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan. .,School of Medicine, MacKay Medical College, New Taipei City, Taiwan. .,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
| | - Allen W Chiu
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan.,School of Medicine, MacKay Medical College, New Taipei City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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15
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Branche B, Crocerossa F, Carbonara U, Klausner AP, Roseman JT, Hampton LJ, Autorino R. Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide. Eur Urol Focus 2021; 8:297-301. [PMID: 33531288 DOI: 10.1016/j.euf.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/16/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
The incidence of bladder neck contracture (BNC), or postprostatectomy vesicourethral anastomosis, has declined since the advent of robotic surgery. However, men with peripheral vascular comorbidities, among other factors, still have a high risk of developing this complication after any surgery that involves manipulation of the prostate. The best strategy for BNC management remains uncertain because of inconsistency in success for different approaches across studies. We reviewed the available evidence on BNC, including the results for endoscopic treatments, scar modulation therapies, and open and robotic bladder neck reconstruction. On the basis of these data, we propose a management flowchart. Patient baseline status and subjective goals and preferences remain crucial in management choices. PATIENT SUMMARY: Contracture of the bladder neck can occur as a complication after surgery to the prostate. We reviewed the evidence for various treatment approaches and propose a flowchart for management of this condition.
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Affiliation(s)
- Brandee Branche
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Fabio Crocerossa
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA; Division of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA; Department of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Adam P Klausner
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - John T Roseman
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lance J Hampton
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.
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Diamant E, de la Taille A, Lavolle A, Chahwan C, M Champy C, Grinholtz D, Hoznek A, Yiou R, Vordos D, Ingels A. [Urethro-vesical anastomosis reconstruction using extra-peritoneal robot-assisted laparoscopy for anastomotic stenosis after radical prostatectomy]. Prog Urol 2021; 31:591-7. [PMID: 33468413 DOI: 10.1016/j.purol.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Urethro-vesical anastomosis stenosis following radical prostatectomy is a rare complication but represents a challenging situation. While the first-line treatment is endoscopic, recurrences after urethrotomies require a radical approach. We present the updated results of our patient's cohort treated by pure robotic anastomosis refection. MATERIAL AND METHODS This is a retrospective, single-center study focusing on one surgeon's experience. Patients presented an urethro-vesical stricture following a radical prostatectomy. Each patient received at least one endoscopic treatment. The procedure consisted of a circumferential resection of the stenosis, followed by a re-anastomosis with well-vascularized tissue. We reviewed the outcomes in terms of symptomatic recurrences and continence after the reconstructive surgery. RESULTS From April 2013 to May 2020, 8 patients underwent this procedure. Half of the patients had previously been treated with salvage radio-hormonotherapy. The median age was 70 years (64-76). The mean operative time was 109minutes (60-180) and blood loss was 120cc (50-250). One patient had an early postoperative complication, with vesico-pubic fistula. The average length of stay was 4.6 days (3-8). Mean follow-up was 24.25 months (1-66). Half of the patients experienced a recurrence at a median time of 8.25 months (6-11) after surgery. Five patients experienced incontinence of which 3 required an artificial urinary sphincter implantation. CONCLUSION Extra-peritoneal robot-assisted urethro-vesical reconstruction is feasible and safe to manage bladder neck stricture after radical prostatectomy. The risk of postoperative incontinence is high, justifying preoperative information. LEVEL OF EVIDENCE III.
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17
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Zhang L, Liu S, Wu K, Mu X, Yang L. Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol 2021; 39:527-32. [PMID: 32367159 DOI: 10.1007/s00345-020-03224-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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18
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Pfalzgraf D, Worst T, Kranz J, Steffens J, Salomon G, Fisch M, Reiß CP, Vetterlein MW, Rosenbaum CM. Vesico-urethral anastomotic stenosis following radical prostatectomy: a multi-institutional outcome analysis with a focus on endoscopic approach, surgical sequence, and the impact of radiation therapy. World J Urol 2020; 39:89-95. [PMID: 32236662 DOI: 10.1007/s00345-020-03157-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/03/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To investigate the predictors of recurrence and of de novo incontinence in patients treated by transurethral incision or resection for vesico-urethral anastomotic stenosis (VUAS) after radical prostatectomy. MATERIAL AND METHODS All patients undergoing endoscopic treatment for VUAS between March 2009 and October 2016 were identified in our multi-institutional database. Digital chart reviews were performed and patients contacted for follow-up. Recurrence was defined as any need for further instrumentation or surgery, and de-novo-incontinence as patient-reported outcome. RESULTS Of 103 patients undergoing endoscopic VUAS treatment, 67 (65%) underwent transurethral resection (TR) and 36 (35%) transurethral incision (TI). TI was performed more frequently as primary treatment compared to TR (58% vs. 37%; p = 0.041). Primary and repeated treatment was performed in 46 (45%) and 57 patients (55%), respectively. Overall, 38 patients (37%) had a history of radiation therapy. There was no difference in time to recurrence for primary vs repeat VUAS treatment, previous vs no radiation, TR compared to TI (all p > 0.08). Regarding treatment success, no difference was found for primary vs. repeat VUAS treatment (50% vs. 37%), previous radiation vs. no radiation (42% vs. 43%), and TR vs. TI (37% vs. 53%; all p ≥ 0.1). Postoperative de novo incontinence was more common after TI vs. TR (31% vs. 12%; p = 0.032), no difference was observed for previous radiation therapy vs. no radiation therapy (18% vs. 18%; p > 0.9) or primary vs. repeat VUAS treatment (22% vs. 16%; p = 0.5). CONCLUSION VUAS recurrence after endoscopic treatment is not predictable. Endoscopic treatment with TI showed a higher risk for de novo incontinence than TR, and previous irradiation and the number of treatments do not influence incontinence.
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Affiliation(s)
- D Pfalzgraf
- Heilig-Geist-Hospital, Bensheim, Germany. .,University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
| | - T Worst
- University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - J Kranz
- St.-Antonius-Hospital, Eschweiler, Germany.,University Medical Centre Halle, Halle, Germany
| | - J Steffens
- St.-Antonius-Hospital, Eschweiler, Germany
| | - G Salomon
- Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Fisch
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C P Reiß
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M W Vetterlein
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C M Rosenbaum
- University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.,Asklepios Clinic Hamburg Barmbek, Barmbek, Germany
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Abstract
PURPOSE OF REVIEW This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral stricture, vesicourethral anastomotic stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer. RECENT FINDINGS Rates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy, radiation therapy, cryoablation, and high-intensity focused ultrasound in contemporary series. Urethral dilation and urethrotomy continue to report moderate patency rates. Urethroplasty achieves high patency rates even for long strictures, but more extensive reconstruction increases the risk of postoperative urinary incontinence. Recent AUA guidelines on urethral strictures provide new recommendations for management of these patients. All treatment options for prostate cancer carry a risk for bladder outlet obstruction, and intervention is often necessary to relieve long-lasting morbidity. Careful preoperative evaluation should be completed to assess location and extent of the stricture in order to choose optimal therapy. Endoscopic treatments, open reconstruction, and urinary diversion all play a role in relief of stenosis depending on stricture length, location, characteristics, and patient comorbidities.
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Affiliation(s)
- Brendan Michael Browne
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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20
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Dinerman BF, Hauser NJ, Hu JC, Purohit RS. Robotic-Assisted Abdomino-perineal Vesicourethral Anastomotic Reconstruction for 4.5 Centimeter Post-prostatectomy Stricture. Urol Case Rep 2017; 14:1-2. [PMID: 28607874 PMCID: PMC5458053 DOI: 10.1016/j.eucr.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/04/2017] [Accepted: 05/10/2017] [Indexed: 12/02/2022] Open
Abstract
We report surgical management of a disrupted radical prostatectomy vesicourethral anastomosis after bleeding from undiagnosed hemophilia that required re-exploration, pudendal artery embolization, and urinary diversion with nephrostomy and surgical drains. After referral, the 4.5 cm vesicourethral anastomotic defect was reconstructed with a robotic-assisted abdomino-perineal approach. Intra-abdominal robotic-assisted mobilization of the bladder and perineal mobilization of the urethra permitted a tension-free vesicourethral anastomosis while avoiding a pubectomy. Side docking of the Da Vinci Xi robot allows for simultaneous access to the perineum during pelvic minimally invasive surgery, enabling a novel approach to complex bladder neck reconstruction.
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Affiliation(s)
- Brian F Dinerman
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | | | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
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Primiceri G, Castellan P, Marchioni M, Schips L, Cindolo L. Bladder Neck Contracture After Endoscopic Surgery for Benign Prostatic Obstruction: Incidence, Treatment, and Outcomes. Curr Urol Rep 2017; 18:79. [PMID: 28795367 DOI: 10.1007/s11934-017-0723-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW In recent years, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate. Nonetheless, complications are still frequently encountered and bladder neck contracture (BNC) is a well-described complication after endoscopic surgery for benign prostatic obstruction (BPO). Our aim is to review and discuss the contemporary incidence, the relevant treatment strategies, and their outcomes. RECENT FINDINGS Findings suggest that BNC is a common complication with an acceptably low incidence but can range in complexity. Most contractures were usually managed successfully with conservative measures; nevertheless, in patients with refractory BNC, various valuable management strategies were employed with different kinds of success and re-treatment rates. In consideration of these challenging possibilities, the treatment of BNC requires a tailored approach with patient-specific management that can range from simple procedures to complex surgical reconstruction.
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22
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Spector BL, Brooks NA, Strigenz ME, Brown JA. Bladder Neck Contracture Following Radical Retropubic versus Robotic-Assisted Laparoscopic Prostatectomy. Curr Urol 2017; 10:145-149. [PMID: 28878598 DOI: 10.1159/000447169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/19/2016] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Radical retropubic prostatectomy (RRP) and robotic-assisted laparoscopic prostatectomy (RALP) are co-standard surgical therapies for localized prostatic adenocarcinoma. These surgical modalities offer similar outcomes; however, lower rate of bladder neck contracture (BNC) is amongst the touted benefits of RALP. The differences between approaches are largely elucidated through multiple-surgeon comparisons, which can be biased by differential experience and practice patterns. We aimed to eliminate inter-surgeon bias through this single-surgeon comparison of BNC rates following RRP and RALP. MATERIALS AND METHODS We retrospectively reviewed all RRPs and RALPs performed by one surgeon over 4 years. We compared clinical characteristics, intraoperative and postoperative outcomes. RESULTS RRP patients had more advanced cancer and a higher biochemical recurrence rate. No significant differences were noted between groups in rates of anastomotic leakage, BNC, or 12-month postoperative pad-free continence. CONCLUSION RRP offers similar outcomes to RALP with regard to postoperative urinary extravasation, urinary continence, and BNC.
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Affiliation(s)
| | - Nathan A Brooks
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | | | - James A Brown
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
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Worst TS, Daskalova K, Steidler A, Berner-Leischner K, Röth R, Niesler B, Weis CA, Kriegmair MC, Erben P, Pfalzgraf D. Novel insights into a reputably irreversible process: combined mRNA and miRNA profiling of tissue from vesicourethral anastomotic stenosis after radical prostatectomy. World J Urol 2017. [PMID: 28634911 DOI: 10.1007/s00345-017-2060-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Until recently, tissue fibrosis-ultimately leading to permanent scaring-has been considered an irreversible process. However, recent findings indicate that it may be reversible after all. Vesicourethral anastomotic stenosis (VUAS) as fibrous narrowing is a frequent complication after radical prostatectomy with high recurrence rates and requires invasive treatment. The pathophysiology is poorly understood. Therefore, a combined mRNA and miRNA transcription profiling in tissue from VUAS was performed using nCounter technology. METHODS To assess tissue morphology and fiber composition, histochemical staining was performed. RNA expression of healthy and fibrotic tissue of twelve patients was analyzed using the human miRNA panel v3 and mRNA PanCancer pathway panel on the nCounter gene1 system and qRT-PCR. Differential expression data analysis was performed using the nSolver software implementing the R-based advanced pathway analysis tool. miRWalk2.0 was used for miRNA target prediction. RESULTS More linearized tissue architecture, increased collagens, and decreased elastic fibers were observed in VUAS samples. 23 miRNAs and 118 protein coding genes were differentially expressed (p < 0.01) in fibrotic tissue. miRNA target prediction and overlap analysis indicated an interaction of the strongest deregulated miRNAs with 29 deregulated mRNAs. Pathway analysis revealed alterations in DNA repair, cell cycle regulation, and TGF-beta signaling. qRT-PCR confirmed differential expression of top deregulated miRNAs and mRNAs. CONCLUSIONS In VUAS tissue, severe alterations on mRNA and miRNA level are found. These consistent changes give insights into the pathogenesis of VUAS after radical prostatectomy and point to future options for transcriptomics-based risk stratification and targeted therapies.
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Affiliation(s)
- T S Worst
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K Daskalova
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Steidler
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K Berner-Leischner
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Röth
- nCounter Core Facility, Department of Human Molecular Genetics, University of Heidelberg, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany
| | - B Niesler
- nCounter Core Facility, Department of Human Molecular Genetics, University of Heidelberg, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany
| | - C-A Weis
- Department of Pathology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M C Kriegmair
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Erben
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - D Pfalzgraf
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Bang SL, Yallappa S, Dalal F, Almallah YZ. Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations. Curr Urol 2017; 10:32-39. [PMID: 28559775 DOI: 10.1159/000447148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. MATERIALS AND METHODS Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. RESULTS The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m2. Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months (range 2-33 months). CONCLUSION Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.
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Affiliation(s)
- Shieh L Bang
- Department of Urology, The Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
| | - Sachin Yallappa
- Department of Urology, The Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
| | - Fatima Dalal
- Department of Urology, The Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
| | - Yahia Z Almallah
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
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Reiss CP, Rosenbaum CM, Becker A, Schriefer P, Ludwig TA, Engel O, Riechardt S, Fisch M, Dahlem R. The T-plasty: a modified YV-plasty for highly recurrent bladder neck contracture after transurethral surgery for benign hyperplasia of the prostate: clinical outcome and patient satisfaction. World J Urol 2016; 34:1437-42. [PMID: 26873595 DOI: 10.1007/s00345-016-1779-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 02/02/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe a modified surgical technique for treatment of highly recurrent bladder neck contracture (BNC) after transurethral surgery for benign hyperplasia and to evaluate success rate and patient satisfaction of this novel technique. METHODS Ten patients with highly recurrent BNC and multiple prior attempts of endoscopic treatment underwent the T-plasty. Perioperative complications were recorded and classified according to the Clavien classification. Patient reported functional outcomes were retrospectively analysed using a standardized questionnaire assessing recurrence of stenosis, incontinence, satisfaction and changes in quality of life (QoL). The questionnaires included validated IPSS and SF-8-health survey items. RESULTS Mean age at the time of surgery was 69.2 years (range 61-79), and the mean follow-up was 26 months (range 3-46). No complications grade 3 or higher according to the Clavien classification occurred. Success rate was 100 %. No de novo stress incontinence occurred. Urinary stream was described as very strong to moderate by 80 % of the patients, mean post-operative IPSS-score was 11.3 (range 4-29), and mean post-operative IPSS-QoL was 2.4 (range 1-5). Patients satisfaction was very high or high in 90 %, and QoL improved in 90 %. The SF-8-health survey showed values comparable to the reference population. CONCLUSION The T-plasty represents a safe and valuable option in treating highly recurrent BNC after surgery for benign hyperplasia. It offers multiple advantages compared to other techniques such as a single-staged approach and the opportunity for reconstruction of a reliable wide bladder neck by usage of two well-vascularized flaps. Success rate, low rate of complications and preservation of continence are highly encouraging.
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Affiliation(s)
- C P Reiss
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - C M Rosenbaum
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - A Becker
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - P Schriefer
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - T A Ludwig
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - O Engel
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Riechardt
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - M Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - R Dahlem
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Parihar JS, Ha YS, Kim IY. Bladder neck contracture-incidence and management following contemporary robot assisted radical prostatectomy technique. Prostate Int 2014; 2:12-8. [PMID: 24693529 PMCID: PMC3970984 DOI: 10.12954/pi.13034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/03/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose: Bladder neck contracture (BNC) is a well-recognized complication following robot-assisted radical prostatectomy (RARP) for treatment of localized prostate cancer with a reported incidence of up to 1.4%. In this series, we report our institutional experience and management results. Methods: A prospectively collected database of patients who underwent RARP by a single surgeon from 2006 to 2012 was reviewed. Watertight bladder neck to urethral anastomosis was performed over 18-French foley catheter. BNC was diagnosed by flexible cystoscopy in patients who developed symptoms of bladder outlet obstruction. Subsequently, these patients underwent cold knife bladder neck incisions. Patients then followed a strict self regimen of clean intermittent catheterization (CIC). We identify the patient demographics, incidence of BNC, associated risk factors and success of subsequent management. Results: Total of 930 patients who underwent RARP for localized prostate cancer was identified. BNC was identified in 15 patients, 1.6% incidence. Mean patient age and preoperative prostate-specific antigen was 58.8 years old and 7.83 ng/mL (range, 2.5–14.55 ng/mL) respectively. Mean estimated blood loss was 361±193 mL (range, 50–650 mL). Follow-up was mean of 23.4 months. Average time to BNC diagnosis was 5.5 months. In three patients, a foreign body was identified at bladder neck. On multivariate analysis, estimated blood loss was significantly associated with development of BNC. All patients underwent cystoscopy and bladder neck incision with a 3-month CIC regimen. Out of 15 index patients, none had a BNC recurrence over the follow-up period. Conclusions: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen.
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Affiliation(s)
- Jaspreet Singh Parihar
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Yun-Sok Ha
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA ; Department of Urology, Kyungpook National University Medical Center, Daegu, Korea
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Abstract
This article presents an overview of reconstruction of lower urinary tract injury caused by radiation therapy for prostate cancer. Discussions include cause, patient evaluation, reconstructive techniques, and outcomes following repair.
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Affiliation(s)
- Nathaniel K Ballek
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Abstract
Bladder neck contracture is a relatively uncommon but well-described complication after the surgical treatment of prostate cancer. Although numerous treatments have been described as an initial management strategy for patients with this condition, the management of refractory cases remains highly variable. This article evaluates various therapeutic maneuvers used for the treatment of refractory bladder neck contracture and further describes the preliminary results of an endoscopic balloon dilation with concomitant deep traunsurethral incision procedure. Short- and long-term management algorithms for patients with recurrent bladder neck contractures are reviewed.
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Affiliation(s)
- Daniel Ramirez
- Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA
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