Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations

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.

Deep lateral transurethral incision for vesicourethral anastomotic stenosis after radical prostatectomy

“…An AUS should be implanted only after the VUAS treatment is completed and the urethral lumen is stabilized; if VUAS recurs after AUS implantation, another transurethral treatment is necessary, which might destroy the implanted AUS or induce urethral injury. 22 Considering that wound healing in the urethra is complete in approximately 10 weeks and most restenosis occurs within 6-8 weeks after DLI, Ramirez et al carried out cystoscopy at 2 months after DLI, and considered that AUS implantation was possible if the cystoscopy could pass through the stenosis. 8 However, the median time to restenosis after the first DLI was 8.1 months in the present cohort.…”

“…The gold standard for treating severe UI after RP is AUS implantation; 21 however, the timing of implantation is controversial in patients with VUAS. An AUS should be implanted only after the VUAS treatment is completed and the urethral lumen is stabilized; if VUAS recurs after AUS implantation, another transurethral treatment is necessary, which might destroy the implanted AUS or induce urethral injury 22 . Considering that wound healing in the urethra is complete in approximately 10 weeks and most restenosis occurs within 6–8 weeks after DLI, Ramirez et al .…”

Robotic Simultaneous Repair of Rectovesical Fistula with Bladder Neck Contracture after Radical Prostatectomy: Step-by-Step Technique and Outcomes

“…Bladder neck contracture (BNC) is de ned as a narrowing of the lumen of the bladder neck that can be seen at the level of the vesicourethral anastomosis (VUA) (2). Their incidence hovers around 1% and 0.3-17.5%, respectively (2)(3)(4)(5).…”

“…Bladder neck contracture (BNC) is de ned as a narrowing of the lumen of the bladder neck that can be seen at the level of the vesicourethral anastomosis (VUA) (2). Their incidence hovers around 1% and 0.3-17.5%, respectively (2)(3)(4)(5). These entities have been recognized as medical conditions for centuries, yet individual management remains challenging due to their rarity and complexity (1,2).…”

“…Their incidence hovers around 1% and 0.3-17.5%, respectively (2)(3)(4)(5). These entities have been recognized as medical conditions for centuries, yet individual management remains challenging due to their rarity and complexity (1,2).…”