Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide

Branche, Brandee; Crocerossa, Fabio; Carbonara, Umberto; Klausner, Adam P.; Roseman, J. Tyler; Hampton, Lance J.; Autorino, Riccardo

doi:10.1016/j.euf.2021.01.007

Cited by 18 publications

(19 citation statements)

References 28 publications

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“…27 Other reports on BNC and SUI management commonly limit follow-up to 1 year or less, and those with longer follow-up tend to have small sample sizes. 11 With a median follow-up time of 5.9 years, the longest follow-up duration available, the present data show a median recurrence interval of 1.4 years. These findings highlight the difficulties with defining BNC stability, suggesting that longer follow-up may be required to fully capture recurrence patterns.…”

Section: Discussionsupporting

confidence: 47%

“…4,8-10 Of the few studies comparing these, there exist widely heterogeneous methodologies, techniques, definitions of stability, and length of follow-up, which provides for conflicting conclusions. 11 Management today continues to rely on expert opinion and data are insufficient for consensus recommendations beyond Grade D (“no recommendation possible”). 12,13…”

Section: Discussionmentioning

confidence: 99%

“…4,[8][9][10] Of the few studies comparing these, there exist widely heterogeneous methodologies, techniques, definitions of stability, and length of follow-up, which provides for conflicting conclusions. 11 Management today continues to rely on expert opinion and data are insufficient for consensus recommendations beyond Grade D ("no recommendation possible"). 12,13 For men with SUI and a history of BNC, the approach used at our institution for over 20 years is to proceed with AUS placement and perform synchronous BNC intervention if the bladder neck is 10F.…”

Section: Discussionmentioning

confidence: 99%

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Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter

Krughoff

Peterson

2023

Journal of Urology

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Purpose:For male cancer survivors, the combination of stress urinary incontinence and recurrent bladder neck contracture presents a management dilemma with poor consensus. Our objective was to assess the impact of artificial urinary sphincter placement on bladder neck contracture recurrence among prostate cancer survivors with stress urinary incontinence and bladder neck contracture.Materials and Methods:Men electing artificial urinary sphincter placement at our institution undergo synchronous bladder neck contracture treatment if indicated. An institutional database was queried for men with stress urinary incontinence and ≥1 intervention for bladder neck contracture. Records were divided according to whether an artificial urinary sphincter was ever placed. The impact of artificial urinary sphincter placement on bladder neck contracture recurrence was assessed using a multivariable conditional survival analysis, with survival defined as the recurrence-free interval following bladder neck contracture intervention. The proportional hazards assumption was assessed on the basis of Schoenfeld residuals.Results:The analytic cohort consisted of 118 in the artificial urinary sphincter group and 88 in the non-artificial urinary sphincter group. Patients in both groups underwent a median of 2 (range 1-8) bladder neck contracture interventions over the entire course of their care, encompassing 445 total bladder neck contracture interventions. The artificial urinary sphincter group was on average 2.6 years younger (P = .02) and had a higher pack-year smoking history (P < .01). The presence of an artificial urinary sphincter was associated with a 61% lower bladder neck contracture re-intervention rate (HR 0.39, P < .01, CI 0.30-0.50) at any time when accounting for number of prior bladder neck contracture interventions and bladder neck contracture risk factors.Conclusions:Artificial urinary sphincter placement is associated with a lower rate of bladder neck contracture re-intervention. Artificial urinary sphincter placement should not be delayed or avoided due to the presence of bladder neck contracture.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter

Krughoff

Peterson

2023

Journal of Urology

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“…The two surgical approaches allowed a high continence rate due to the preservation of anterior ligaments of the bladder as well as prevention of vesical-urethral anastomosis prolapse with the attempt to maintain as much normal pelvic anatomy as possible [29] . Overall, the robotic platform improved functional outcomes of patients undergoing RP compared with the open and laparoscopic approaches [5] , [30] .…”

Section: Discussionmentioning

confidence: 97%

Xi Nerve-sparing Robotic Radical Perineal Prostatectomy: European Single-center Technique and Outcomes

Carbonara

Minafra

Papapicco

et al. 2022

European Urology Open Science

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“…Unfortunately, the past literature has not been differentiating between vesicourethral anastomosis stenosis and bladder neck contracture precisely. It should be highlighted, that a differentiation between bladder neck contracture, which can occur after surgical procedures for benign prostatic hyperplasia and vesicourethral anastomosis stenosis after radical prostatectomy, is inevitable, since anatomy, recurrence rates and functional outcomes differ significantly ( 68 , 69 ). Since a small subgroup of PCa patients might receive a palliative endoscopic procedure, bladder neck contracture and urethral strictures are listed as potential complications following PCa treatments, however, the majority of patients presenting with obstructive outlet following prostate cancer treatment will suffer of vesicourethral anastomosis stenosis.…”

Section: Vesicourethral Anastomosis Stenosis Bladder Neck Contracture and Urethral Stricturesmentioning

confidence: 99%

Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion – A Narrative Review

et al. 2021

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The purpose of this narrative review is to discuss and highlight recently published studies regarding the surgical management of patients suffering from prostate cancer treatment complications. Focus will be put on the recalcitrant and more complex cases which might lead to urinary diversion as a definite, last resort treatment. It is in the nature of every treatment, that complications will occur and be bothersome for both patients and physicians. A small percentage of patients following prostate cancer treatment (radical prostatectomy, radiation therapy, or other focal therapies) will suffer side effects and thus, will experience a loss of quality of life. These side effects can persist for months and even years. Often, conservative management strategies fail resulting in recalcitrant recurrences. Prostate cancer patients with “end-stage bladder,” “devastated outlet,” or a history of multiple failed interventions, are fortunately rare, but can be highly challenging for both patients and Urologists. In a state of multiple previous surgical procedures and an immense psychological strain for the patient, urinary diversion can offer a definite, last resort surgical solution for this small group of patients. Ideally, they should be transferred to centers with experience in this field and a careful patient selection is needed. As these cases are highly complex, a multidisciplinary approach is often necessary in order to guarantee an improvement of quality of life.

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Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide

Cited by 18 publications

References 28 publications

Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter

Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter

Xi Nerve-sparing Robotic Radical Perineal Prostatectomy: European Single-center Technique and Outcomes

Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion – A Narrative Review

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