Incision technique shows potential for bladder neck contracture

A US team reports that deep lateral transurethral incisions (TUI) are a promising technique for the treatment of recurrent bladder neck contracture (BNC) in men following prostate surgery.

Allen Morey and colleagues, from the University of Texas Southwestern Medical Center in Dallas, say their 5-year experience of the treatment indicates that it could provide an alternative to other options, such as those requiring patients to self-catheterize, and avoid the need for endoscopic injections.

The team reviewed the outcomes of 50 men consecutively treated at their institution between June 2007 and January 2012, with a median follow-up of 16 months. Most of the men had developed BNC after prostatectomy (70%) or transurethral procedures for benign prostatic hyperplasia (26%), and 78% had undergone unsuccessful treatment elsewhere.

But, following treatment with the novel technique – which involves dilation of the BNC followed by two deep lateral incisions through the muscle fibers – only 28% of the 50 men required further treatment for recurrence after 2 months, half of whom were successfully treated with a repeat procedure.

On univariate analysis, the team found that having a greater than 10 pack–year smoking history was associated with TUIBNC failure, with treatment failing in 71.4% of such patients compared with only 38.9% of patients with lesser smoking histories. Additionally, patients who had two or more prior endoscopic procedures for BNC had a 40.7% failure rate compared with 13.0% in patients with fewer procedures.

The team highlights that concurrent stress urinary incontinence was not uncommon, occurring in 78% of the cohort before surgery and another patient after TUIBNC. Of these 40 patients, 65% underwent subsequent surgery for incontinence, primarily with an artificial urinary sphincter (AUS) placement. Only 21% of these men required AUS revision, which was mostly for cuff downsizing, and at follow-up, none had AUS erosions or infections. BNC recurrence was reported in only two patients following AUS placement.

Writing in Urology, Morey and team note that, owing to the rarity of recurrent BNC, the power of their study is limited.

Nevertheless, they conclude that TUIBNC “constitutes a novel controlled approach for a uniquely challenging group of patients, most of whom had failed previous interventions to relieve obstruction.”

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