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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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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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