Deep Lateral Transurethral Incisions for Recurrent Bladder Neck Contracture: Promising 5-Year Experience Using a Standardized Approach

Ramírez, Daniel; Zhao, Lee C.; Bagrodia, Aditya; Scott, Jeremy; Hudak, Steven J.; Morey, Allen F.

doi:10.1016/j.urology.2013.08.018

Cited by 70 publications

(65 citation statements)

References 19 publications

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“…Ramirez and colleagues performed deep lateral transurethral incisions for recurrent VUAS in 50 patients. 49 Patients underwent balloon dilation to open the stenosis followed by incisions into the perivesical fat using a Collings knife on cutting current at the 3 and 9 o'clock positions. They reported being able to successfully pass a flexible cystoscope into the bladder in 72% of patients at a mean 13 months of follow up.…”

Section: Endourologic Treatmentmentioning

confidence: 99%

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Rocco

Zuckerman

2017

Therapeutic Advances in Urology

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Postprostatectomy vesicourethral anastomotic stenosis (VUAS) remains a challenging problem for both patient and urologist. Improved surgical techniques and perioperative identification and treatment of risk factors has led to a decline over the last several decades. High-level evidence to guide management is lacking, primarily relying on small retrospective studies and expert opinion. Endourologic therapies, including dilation and transurethral incision or resection with or without adjunct injection of scar modulators is considered first-line management. Recalcitrant VUAS requires surgical reconstruction of the vesicourethral anastomosis, and in poor surgical candidates, a chronic indwelling catheter or urinary diversion may be the only option. This review provides an update in the diagnosis and management of postprostatectomy VUAS.

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Section: Endourologic Treatmentmentioning

confidence: 99%

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Rocco

Zuckerman

2017

Therapeutic Advances in Urology

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“…KTP (80 W) group and XPS (180 W) group had similar perioperative and postoperative parameters, except for the shorter irradiation time in XPS (180 W) group. BNC is an uncommon but challenging complication that might occur following the surgical treatment of benign and malignant prostate conditions, which is known to occur in 0.5-17.5 % of patients having radical prostatectomy and in 1-12 % after TURP or PVP [19]. The majority of patients with BNC will endure some voiding symptoms, such as lower urinary tract voiding symptoms, recurrent urinary tract infection, and the need for repeat urethral procedures such as urethral dilation or reoperation [20].…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus, obesity, smoking history, advanced age, coronary artery disease, increased operative time, surgical technique, and certain postoperative complications (hemorrhage, prolonged urine leak, anastomotic disruption) were generally considered as the risk factors for the development of BNC after radical prostatectomy [21]. However, the previous studies were mostly focused on the techniques of surgical managements of BNC developed after radical prostatectomy [19,21]. The reasons for development of BNC after PVP remain unknown.…”

Section: Discussionmentioning

confidence: 99%

A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laser photoselective vaporization of benign prostatic hyperplasia

Song

Liu

et al. 2016

Lasers Med Sci

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Bladder neck contracture (BNC) after GreenLight laser photoselective vaporization (PVP) of benign prostatic hyperplasia is a common complication. In the present study, data of patients received 80 or 180 W PVP were collected. Perioperative parameters, including applied energy, irradiation time, catheter removal time, and hospital stay, were recorded. Postoperative parameters, including maximum urinary flow rate, International Prostate Symptom Score, post-void residual volume, and incidences of BNC, were recorded at 3 and 12 months after operations. Bladder neck tissues were taken at 3 months after operations for immunohistochemical staining and western blot analysis to examine the expressions of collagen I, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β). Sample size of patients was calculated with a power of 80 %. Chi-square test and one-way analysis of variance were performed as statistical methods. Three hundred twenty-six patients who received potassium titanyl phosphate (KTP) laser and 256 who received X-ray photoelectron spectroscopy (XPS) laser entered into the study. Perioperative parameters were comparable, except for shorter irradiation time in 180 W group (P = 0.032). Postoperative parameters were also similar, except for higher incidence of BNC in 80 W group at 3 months after operations (P = 0.022). Immunohistochemical staining and western blot analysis showed higher expressions of collagen I, MMP-3, and TGF-β in 80 W group than in 180 W group. In conclusion, 80 W GreenLight laser showed a comparable efficacy with 180-W laser in PVP but showed a higher incidence of BNC in short term, which might be the result of up-regulated fibrotic factors in bladder neck triggered by lasers.

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“…In their cohort of 50 consecutive patients, 72 % (36/50) required no further therapy at a mean follow-up of 12.9 months with an additional 14 % (7/14) patients achieving successful patency with a second dilation and incision. Of their patients who subsequently went on to have an AUS placed, only 8 % (2/26) required further treatment for their BNC post-AUS placement [17].…”

Section: Endourologic Treatmentmentioning

confidence: 99%

“…The need for retreatment of a BNC after placement of an AUS in properly selected patients is fortunately low [16,17]. In this challenging clinical scenario, we generally prefer to attempt transurethral incision using a holmium laser.…”

Section: Endourologic Treatmentmentioning

confidence: 99%

Management Strategies for Post-Prostatectomy Bladder Neck Contractures

Kovell

Terlecki

2015

Curr Urol Rep

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Patients who develop bladder neck contracture (BNC) after surgical treatment for prostate cancer often present with progressive lower urinary tract symptoms. Multiple risk factors contribute to BNC development including patient-related factors and technical considerations at the time of surgery. Initial management begins with endoscopic therapies, including dilation, transurethral incision (TUIBNC), and injection of adjunctive agents. When BNC remains refractory to these therapies, surgical reconstruction of the vesicourethral anastomosis or urinary diversion can be considered in select cases. This review presents an outline of the management of BNC after radical prostatectomy (RP), highlighting the recent literature related to the subject.

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Deep Lateral Transurethral Incisions for Recurrent Bladder Neck Contracture: Promising 5-Year Experience Using a Standardized Approach

Cited by 70 publications

References 19 publications

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laser photoselective vaporization of benign prostatic hyperplasia

Management Strategies for Post-Prostatectomy Bladder Neck Contractures

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