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Introduction: Secondary bladder neck sclerosis (BNS) represents a common late complication of prostate surgery, however so far insufficiently assessed in the available literature. More over, the previously attempted and analyzed therapeutic modalities failed to achieve acknowledgement as standard treatment for this particular pathology. Methods: The bipolar plasma vaporization (BPV) was introduced as a viable mean of removing the obstructing scar formation in a gradual fashion. Several "tips and tricks" were described as particularly useful in optimizing the plasma corona vaporization effect. The proper BPV technique is simple and safe while closely relying on certain surgical steps, the simultaneous vaporization and coagulation processes and a superior endoscopic vision. Recent technological advances created the premises for further improvements. Results: The plasma-button vaporization is characterized by a satisfactory surgical speed, remote intraoperative bleeding risks, high-quality endoscopic visibility as well as the achievement of a complete sclerotic tissue removal. Within a short learning curve, a superior final aspect of the prostatic fossa and bladder neck is obtained at the end of surgery. The continuous plasma vaporization mode provides additional technical advantages. The previously described drawbacks of transurethral incision or resection seem to have been overcome by the practical features of the plasma vaporization process. Conclusions: The BPV technique outlines a promising modality of efficiently ablating the obstructing fibrous tissue in secondary BNS patients. The simplicity and safety of the bipolar vaporization approach, together with the thorough obstructing scar removal in a radical fashion, create the premises for a favorable long term BPV clinical outcome.

Introduction: A long term, retrospective study was performed aiming to outline a critical comparison concerning the efficacy, safety and durability of the bipolar plasma vaporization (BPV), standard monopolar transurethral resection (TUR) and “cold-knife" “star" transurethral incision (TUI) in secondary bladder neck sclerosis (BNS) cases. Materials & Methods: Of the 126 patients included in the trial based on maximum flow rate (Qmax) below 10 mL/s and International Prostate Symptom Score (IPSS) over 19, classical resection was performed in 46 cases, “cold-knife" TUI in 37 cases and bipolar vaporization in 43 patients. The evaluation protocol comprised IPSS, QoL (quality of life) score, Qmax and PVR (post-voiding residual urinary volume) assessment performed at 1, 3, 6, 12, 18 and 24 months after the initial intervention. Results: Significant intraoperative complications (capsular perforation – 8.7%; bleeding – 4.3%) occurred secondary to monopolar resection. “Star" TUI was the fastest technique, followed by plasma-button vaporization (7.2 and 11.4 versus 16.5 minutes). BPV and TUI patients benefitted from the shortest catheterization periods (0.75 and 1 versus 2.0 days) and hospital stays (1.0 and 1.25 versus 2.0 days). Immediate postoperative adverse events consisted of hematuria (6.5% of the TUR cases) and acute urinary retention (8.1% of the TUI group). Significantly higher long term BNS recurrence rates requiring re-treatment were established in the TUI (18.7%) and TUR (12.8%) series by comparison to BPV (5.4%). Among patients that completed the follow-up protocol, equivalent IPSS, QoL, Qmax and PVR features were determined in the 3 study arms. Conclusions: The plasma vaporization approach was confirmed as a successful match to conventional TUR and “cold-knife" TUI in terms of surgical safety profile, postoperative recovery, therapeutic durability and urodynamic and symptom score parameters.

Introduction: High-grade obesity raises some specific problems regarding the endourological approach. The aim of our study was to determine if this pathology might influence the outcome of retrograde ureteroscopy. Materials and methods: We evaluated the outcome of 88 ureteroscopies performed in highly obese patients during the last 5 years. The data were compared with the results of 88 consecutive ureteroscopies performed in normal weight patients. Results: The success rate in the study group was of 91% by comparison with 95% in the normal weight group. The use of flexible ureteroscopes was imposed in 17% of the obese group vs. 11% in the control group. The complications rate (all mild) was of 6.8% in the obese group vs. 4.5% in the normal weight patients. The differences between the two groups, although present, were not statistically significant. However, in two cases with obesity, the weight of the patients was too high for the operating table, imposing supplementary sustaining measures. Conclusions: Ureteroscopic treatment of stones in obese patients is an acceptable treatment modality, with success rates similar to non-obese patients. Sometimes it may require some logistic measures in the operating theatre.