Search

Daniele Castellani,1 Silvia Stramucci,1 Bhavatej Enganti,2 Jenni Lane,3 Santosh Kumar,4 Yiloren Tanidir,5 Alba Farré,6 Boyke Soebhali,7 Vigen Malkhasyan,8 Nariman Gadzhiev,9 Marek Adam Zawadzki,10 Pankaj Nandkishore Maheshwari,11 Khi Yung Fong,12 Giacomo Maria Pirola,13 Angelo Naselli,13 Apurva Anand,14 Shreyas K Bhadranavar,14 Bhaskar K Somani,3 Andrea Benedetto Galosi,1 Vineet Gauhar15 1Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; 2Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India; 3Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK; 4Department Urology, Christian Medical College, Vellore, India; 5Unit of Urology, Marmara University, Pendik Research and Education Hospital, Istanbul; 6Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain; 7Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Mulawarman University, Samarinda, Indonesia; 8Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation; 9Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation; 10Urology Unit, St. Anna Hospital, Piaseczno, Poland; 11Department of Urology, Fortis Hospital Mulund, Mumbai, India; 12Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 13Urology Unit, San Giuseppe Hospital, Multimedica Group, Milan, Italy; 14Urology Unit, Kulkarni Reconstructive Urology Center, Pune, India; 15Department of Urology, Ng Teng Fong Hospital, NUHS, Singapore, SingaporeCorrespondence: Daniele Castellani, Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy, Tel +39715963571, Fax +39715963367, Email castellanidaniele@gmail.comPurpose: To assess management and outcomes of bladder neck stenosis (BNS) post-transurethral resection of the prostate (TURP) in 12 centers.Patients and Methods: A retrospective analysis of patients who underwent transurethral BN incision for stenosis following TURP from January 2015 and January 2023 was performed. Inclusion criteria included endoscopic diagnosis of BNS associated with obstruction and/or lower urinary tract symptoms. Data are presented as median and interquartile range. Two distinct univariable logistic regression analyses were performed to identify factors associated with overall urinary incontinence and recurrent stenosis.Results: Three hundred and seventy-two men were included. 95.2% of patients developed BNS following bipolar TURP. 21.0% of patients were on an indwelling catheter before BNS incision. Bipolar electrocautery was the most commonly employed energy for incision (66.5%). Collings knife was the most commonly employed (61.2%) instrument for incision, followed by end-firing holmium lasering (35.3%). Median operation time was 30 (25– 45) minutes. The overall complication rate was 12.4%, with 19 (5.1%) patients suffering from acute urinary retention, 6 (1.6%) patients requiring prolonged irrigation due to persistent hematuria, and a surgical hemostasis was necessary in 8 cases (2.2%). Overall postoperative incontinence rate was 17.2%, with urge incontinence accounting for the most common type (45.3%). Incontinence lasted more than 3 months in 9/46 (14.3%) patients. Recurrent BNS occurred in 29 (7.8%) patients and was managed by re-endoscopic incision in 21 (5.6%) patients and dilatation only in 6 (1.6%) patients. Two (0.5%) patients underwent urethroplasty for recalcitrant stenosis. Logistic regression analysis showed that Collings knife was associated with higher odds of having postoperative incontinence (OR 3.93 95% CI 1.45– 11.13, p=0.008) and BN recurrence (OR 3.589 95% CI 1.157– 15.7, p=0.047).Conclusion: Transurethral BN incision provides satisfactory short-term results with an acceptable rate of complications.Keywords: bladder neck stenosis, transurethral resection of the prostate, postoperative complications, urinary incontinence

Introduction. High recurrence rate of bladder neck stenosis after application of existing endoscopic and reconstructive surgeries determines the relevance of studying new methods of treatment. In this respect, it is promising to study the possibilities of thulium laser.Objective. To study the efficacy and safety of a thulium laser for the treatment of benign bladder neck stenosis.Materials & methods. The study included 24 men with bladder neck stenosis of benign aetiology who underwent surgical treatment using the «Urolaz» (“IRE-Polus”, Fryasino, Russian Federation) thulium fibre laser. The treatment results were evaluated 3, 6, 12, 18 and 24 months (mo) after surgery, and then annually.Results. Postoperative follow-up time ranged from 3 to 50 mo (mean 21.1 ± 7.1 mo). With these follow-up periods, treatment was successful in 21 (87.5%) patients. The average period of recurrence was 2.8 ± 1.1 mo after surgery. A significant improvement in the following parameters was found in all periods of postoperative follow-up relative to preoperative data: maximum urination rate, average urination rate, residual urine volume, IPSS scores, and quality of life (p < 0.05). Early and late postoperative complications occurred in 8 (33.3%) and 2 (8.3%) patients, respectively, and all of them were mild and corresponded to the Clavien-Dindo I.Conclusions. The use of a thulium fibre laser for benign bladder neck stenosis makes it possible to achieve sufficiently high rates of efficiency and safety of treatment. This method can be considered among the main treatment options for this disease.

Monopolar Transurethral Resection of the Prostate (TURP) is the commonly done procedure for surgical removal of the prostate after open prostatectomy in our subregion. It is still a novel procedure in our subregion, as very few centers offer this procedure. It is generally believed that the size of the prostate may influence the development of complications of bladder neck stenosis. This is a dreaded complication, which requires further surgical procedure to correct in a resource-poor environment. We decided to compare the incidence of Bladder Neck Stenosis (BNS) in small vs larger prostates following monopolar TURP in our black African subregion. We prospectively studied 194 patients who underwent TURP in our facility from 2015 to 2022 that satisfied the inclusion criteria. Eighty-five participants (43.81%) had a small prostate (Transrectal Ultrasound, TRUS, weight <30 g), and 109 participants (56.19%) had a large prostate (TRUS weight >30 g). Overall, ten participants (5.15%) had postoperative BNS. Participants with smaller prostates had more incidence of bladder neck contracture than those with larger prostates, although this did not reach statistical significance, Fisher's Exact test p=0.338. Multifactorial reasons and not prostate size alone may be responsible for BNS. There may be a need for larger-scale standardized studies on prostate size effect on BNS. [ABSTRACT FROM AUTHOR]

Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. Methods: In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan–Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Results: Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). Conclusions: A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis. [ABSTRACT FROM AUTHOR]

The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications. [ABSTRACT FROM AUTHOR]

Introduction. Inflammation and fibrosis may have a significant role in pathogenesis of benign prostatic hyperplasia and associated lower urinary tract symptoms. Moreover, those factors may compromise the outcomes of surgical interventions for bladder outlet obstructions, such as transurethral resection of the prostate (TURP). Additional measures, such as administration of anti-fibrotic agents, may decrease the incidence of certain complications (e.g. bladder neck stenosis, urethral stricture) and improve overall outcomes of TURP. Bovhyaluronidase azoximer is an enzyme combined with high molecular mass copolymer which may inhibit surgery-related tissue remodeling and prevent excessive fibrosis.Materials and methods. Sixty-five patients undergoing monopolar TURP were enrolled in this prospective randomized open-label study. Patients in Group 1 (n = 34) received 5 intramuscular injections of bovhyaluronidase azoximer (3000 IU) on days 3, 6, 9, 12 and 15 after TURP in addition to standard therapy. Patients in Group 2 (n = 31) received conventional peri-operative therapy. All patients routinely underwent uroflowmetry and post-void residual volume measurement on follow-up 3 months after TURP. Incidence of fibrosis-associated complications was compared using Fisher’s exact test. Uroflowmetric parameters were compared using Mann-Whitney U-test.Results. One patient in Group 1 was excluded from the study due to mild allergic reaction after second injection of bovhyaluronidase azoximer. There were three cases of clinically significant fibrosis-associated complications in Group 2 which were confirmed on imaging (9.7 %). One case of stricture in bulbar urethra was later successfully managed with anastomotic urethroplasty, and two cases of bladder neck stenosis were managed with transurethral incision. No such complications were observed in Group 1 (0 %). However, the difference was not statistically significant (p = 0.1079). Otherwise, there were no adverse events in both groups. Median Qmax in Groups 1 and 2 was 24 ml/s and 22 ml/s, respectively (p = 0.08). Median Qave in Groups 1 and 2 was 15 ml/s and 9 ml/s, respectively (p

Introduction. Bladder neck stenosis (BNS) is a late complication of surgical treatment for benign prostatic hyperplasia. Available methods of endoscopic correction in primary BNS have limited effectiveness, while in recurrent cases their use does not lead to satisfactory results at all. YV-plasty of the bladder neck (BN) is one of the available methods of treatment for recurrent BNS.Purpose of the study. To evaluate the treatment results of patients with recurrent BNS using endovideoscopic YV-plasty of the BN.Materials and methods. We retrospectively analyzed the treatment results of 8 patients with recurrent BNS who underwent endovideoscopic YV-plasty of the BN in the Urology Division No.1 of the St. Luke St. Petersburg Clinical Hospital from 2019 to 2021.Results. Endovideoscopic YV-plasty of the bladder neck was successfully performed in all 8 patients. The mean preoperative Qmax was 3.7 ml/s (1.8 – 5.7). At 6 months after surgery, the mean Qmax was 21.4 mL/s (16.7 – 24.1). The mean preoperative I-PSS score was 20.5 (17 – 24). The mean I-PSS score 6 months after surgery was 7.1 (5.0 – 9.0). No cases of de-novo stress urinary incontinence were registered.Conclusions. Endovideoscopic YV-plasty of the BN may be an effective and safe method of treatment of patients with recurrent BNS. However, further studies are needed to obtain long-term results.

Background: Urethral strictures are a common and persistent pathology in urology with significant clinical repercussions. Our aim is to provide an overview of the general aspects of this condition., Methods: A comprehensive review of the literature from PubMed was conducted covering the period from 2020 to 2023. This was complemented by a synthesis of the latest guidelines from the American, European, and French Urological Associations (AUA, EAU, AFU), as well as references from textbooks., Results: Urethral stricture is defined by a narrowing of less than 16 French. The urethra is divided into posterior and anterior parts. The prevalence of urethral stricture is approximately 0.9%. The most common location for strictures is the anterior urethra, particularly its bulbar portion in males. The main causes are idiopathic, iatrogenic, traumatic, inflammatory, and infectious. A better understanding of urethral anatomy and histopathology provides a key element. Urethral reconstruction is based on prior urethral rest, detailed analysis of the stricture characteristics, and the use of grafts and flaps., Conclusion: Urethral strictures remain a broad pathology. Their definition and epidemiology have been clarified. They require a thorough understanding of the anatomy, etiologies, and principles of urethral reconstruction to optimize management., (Copyright © 2024. Published by Elsevier Masson SAS.)

Abstract Background Malament stitch is one of the effective techniques employed to minimize bleeding in simple open prostatectomy but concerns about possibility of increased risk of bladder neck stenosis has limited its routine use. Aim We studied patients who had open prostatectomy with Malament stitch to determine the incidence of bladder neck stenosis amongst them. Material and methods This was a prospective study of 72patients who had simple open prostatectomy in which malament stitch was applied from 2010 to 2020. A proforma was designed to collect data. Pretreatment variables were transrectal ultrasound (TRUS) volume of prostate, pretreatment IPSS value, postvoidal residual urine volume before surgery, weight of enucleated prostate adenoma, time to removal of Malament stitch. Outcome measures were done with post treatment IPSS and PVR at 6 weeks, 3 months and 6 months. Cystoscopy was done at 3 months or 6 months for patients with rising outcome measures to determine presence of bladder neck stenosis. Results The mean age of patients in this study was 68.3 years (SD = 7.1, range 52–82). The mean of the pretreatment score for IPSS was 30.7 (SD = 3.9, range 18–34) and 5.9 (SD = 0.2) for QOLS. The mean weight of prostate estimated with ultrasound was 169.5 g and mean weight of enucleated adenoma of the prostate was 132.5 g. The mean time of removal of Malament stitch was 23.1 h. Only 3 (4.2%) patients required cystoscopy because of increasing IPSS and PVR at 3 months postprostatectomy. 2 (2.8%) patients out of 72patients were confirmed to have bladder neck stenosis at cystoscopy. Conclusion Malament stitch did not lead to significant incidence of bladder neck stenosis in this study.

We assessed the incidence and risks factors of bladder neck and urethral stenosis after Thulium laser enucleation of the prostate. Patients who underwent surgery at two centres were retrospectively reviewed (December 2014–June 2020). Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, prostate cancer, neurogenic bladder, history of bladder neck and urethral stenosis, concomitant transurethral surgery, active urinary tract infection. Significant variables at univariate analysis (p < 0.05) were included in a multivariate logistic regression analysis to establish their association with bladder neck/urethral stenosis. One thousand and three patients were included. Median age was 69.0 (63.0–75.0) years. Median prostate volume was 65.0 (46.3–82.0) ml. Median follow‐up was 31 (25–75) months. Thirty patients (2.99%) developed bladder neck stenosis [median time after surgery: 15 (11–17.75) months], 50 patients (4.98%) urethral stenosis [median time after surgery: 9 (7–11) months]. Men with bladder neck and urethral stenosis had significantly smaller prostate volume (median volume 43.5 ml vs. 66.0 ml, p = 0.008, and 52.0 ml vs. 66.0 ml, p = 0.009, respectively). At multivariable analysis, short surgical time predicted for bladder neck stenosis (OR 0.973; 95% CI 0.957–0.994, p = 0.002), and re‐catheterization (OR 3.956; 95% CI 1.867–8.382, p < 0.001) for urethral stenosis, whereas prostate volume was significantly associated with a lower incidence of US (OR 0.984, 95% CI 0.972–0.998, p = 0.03). [ABSTRACT FROM AUTHOR]

Background: Malament stitch is one of the effective techniques employed to minimize bleeding in simple open prostatectomy but concerns about possibility of increased risk of bladder neck stenosis has limited its routine use.Aim: We studied patients who had open prostatectomy with Malament stitch to determine the incidence of bladder neck stenosis amongst them.Material and Methods: This was a prospective study of 72patients who had simple open prostatectomy in which malament stitch was applied from 2010 to 2020. A proforma was designed to collect data. Pretreatment variables were transrectal ultrasound (TRUS) volume of prostate, pretreatment IPSS value, postvoidal residual urine volume before surgery, weight of enucleated prostate adenoma, time to removal of Malament stitch. Outcome measures were done with post treatment IPSS and PVR at 6 weeks, 3 months and 6 months. Cystoscopy was done at 3 months or 6 months for patients with rising outcome measures to determine presence of bladder neck stenosis.Results: The mean age of patients in this study was 68.3 years (SD = 7.1, range 52-82). The mean of the pretreatment score for IPSS was 30.7 (SD = 3.9, range 18-34) and 5.9 (SD = 0.2) for QOLS. The mean weight of prostate estimated with ultrasound was 169.5 g and mean weight of enucleated adenoma of the prostate was 132.5 g. The mean time of removal of Malament stitch was 23.1 h. Only 3 (4.2%) patients required cystoscopy because of increasing IPSS and PVR at 3 months postprostatectomy. 2 (2.8%) patients out of 72patients were confirmed to have bladder neck stenosis at cystoscopy.Conclusion: Malament stitch did not lead to significant incidence of bladder neck stenosis in this study. [ABSTRACT FROM AUTHOR]

Background: The use of grafts is commonly employed in urologic reconstructive surgery. In poorly accessible surgical areas, graft fixation can be difficult. To improve the efficiency of quilting and suturing in challenging spaces, an improvised surgical “sewing machine” (ISSM) was developed. Materials and Methods: Preoperatively, all patients were confirmed to have lumen stenosis (vaginal, urethra, bladder neck). Intraoperatively, following incision through the stenosed segments and harvesting buccal mucosa graft (BMG), the ISSM device was assembled using materials readily available in the operating room. The device was assembled by threading absorbable 4–0 barbed suture through a 20-gauge hollow needle. The parts lacking the barbs were excised. For graft quilting the needle was introduced in and out of the graft positioned on the graft bed tissue. The barbs held the suture in place allowing for easy needle removal, forward advancement and reintroduction into the tissue to create a continuous running suture for graft quilting. Results: A total of 13 patients (11 men, 1 cis-gender female and 1 transgender female) with a mean age of 68 years (29–79 years) underwent buccal mucosa graft (BMG) quilting with the ISSM between January 2017 and October 2019. Surgeries performed included 8 posterior urethroplasties with BMG augmentation [1–2], 1 transvesical bladder neck reconstruction [3], 2 augmented perineal urethrostomy [4], 1 female dorsal only BMG urethroplasty [5] and 1 revision vaginoplasty. Of these, 7 patients had prior pelvic radiation. At a mean follow-up of 46 weeks (6–127 weeks) graft survival was demonstrated in all patients and there was no disease recurrence. Suture resorption occurred between 12–20 weeks postoperatively. Conclusion: The improvised surgical “sewing machine”, ISSM can be used in a variety of complex reconstructive surgeries, including those involving radiated tissue, where graft fixation and suturing is challenging without compromising surgical outcomes. Future applications in endoscopic and laparoscopic surgery are possible.

Objectives: To investigate the predictors of recurrence and of de novo incontinence in patients treated by transurethral incision or resection for vesico-urethral anastomotic stenosis (VUAS) after radical prostatectomy. Material and methods: All patients undergoing endoscopic treatment for VUAS between March 2009 and October 2016 were identified in our multi-institutional database. Digital chart reviews were performed and patients contacted for follow-up. Recurrence was defined as any need for further instrumentation or surgery, and de-novo-incontinence as patient-reported outcome. Results: Of 103 patients undergoing endoscopic VUAS treatment, 67 (65%) underwent transurethral resection (TR) and 36 (35%) transurethral incision (TI). TI was performed more frequently as primary treatment compared to TR (58% vs. 37%; p = 0.041). Primary and repeated treatment was performed in 46 (45%) and 57 patients (55%), respectively. Overall, 38 patients (37%) had a history of radiation therapy. There was no difference in time to recurrence for primary vs repeat VUAS treatment, previous vs no radiation, TR compared to TI (all p > 0.08). Regarding treatment success, no difference was found for primary vs. repeat VUAS treatment (50% vs. 37%), previous radiation vs. no radiation (42% vs. 43%), and TR vs. TI (37% vs. 53%; all p ≥ 0.1). Postoperative de novo incontinence was more common after TI vs. TR (31% vs. 12%; p = 0.032), no difference was observed for previous radiation therapy vs. no radiation therapy (18% vs. 18%; p > 0.9) or primary vs. repeat VUAS treatment (22% vs. 16%; p = 0.5). Conclusion: VUAS recurrence after endoscopic treatment is not predictable. Endoscopic treatment with TI showed a higher risk for de novo incontinence than TR, and previous irradiation and the number of treatments do not influence incontinence. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Preliminary results of a case series on refractory bladder neck stenosis treated with laparoscopic T-plasty are presented in this article. This study retrospectively identified nine patients with refractory bladder neck stenosis aged 60 to 80 years between May 2016 and December 2017, who had undergone laparoscopic T-plasty. All patients presented voiding difficulty and failed after two or more prior endoscopic treatments. Laparoscopic T-plasty was performed by incising the anterior wall of the bladder neck in a T-shaped manner and creating two well-vascularized and tension-free flaps, which offer the possibility to reconstruct a wide bladder neck. After a mean follow-up of 14.7 months (ranging 3-22 months), a successful outcome was achieved in eight patients without incontinence secondary to surgery. Recurrent voiding difficulty developed in one patient, which was cured after a following endoscopic treatment. Through these nine patients, a preliminary conclusion can be drawn that a wider bladder neck can be obtained through modified YVreconstruction of the bladder neck, while avoiding external urethral sphincter injury. And laparoscopic T-plasty has clear advantages compared with an open approach. It is an available and effective option for refractory bladder neck stenosis. [ABSTRACT FROM AUTHOR]

Introduction: Open adenomectomy of the prostate, although performed less frequently, is still indicated in patients with prostate adenoma > 100 ml. Aim: This study assessed the frequency of isolated bladder neck stenosis after surgery and the effectiveness of internal optical urethrotomy as monotherapy and in combination with transurethral resection in the treatment of this complication. Material and methods: One thousand five hundred thirty-eight Millin's operations and 381 trans-vesical adenomectomies were performed in patients with prostate adenoma. In 50 patients, the circular hemostatic suture was applied using the de la Peña technique because of bleeding after surgery. The retrospective analysis compared the incidence of isolated bladder neck stenosis depending on the type of surgery. Results: Isolated bladder neck stenosis or narrowing of the neck combined with partial stenosis of the site after adenomectomy occurred in 0.52% (8/1539) of patients after Millin's operation and in 1.05% of patients (4/381) after trans-vesical adenomectomy. All strictures of the bladder after trans-vesical surgery occurred within 12 month after the procedure, and 25% of stenoses after Millin's operation occurred many years after the surgery. Internal optical urethrotomy as monotherapy or in combination with scar resection resulted in recovery after one treatment in 16 out of 17 patients. Conclusions: Internal optical urethrotomy as monotherapy or in combination with scar resection was effective in nearly all patients with bladder neck stenosis. [ABSTRACT FROM AUTHOR]

Objective: To report the experience with our technical modification of the trigone-bladder neck complex management in the prevention of bladder neck stenosis (BNS) following open simple retropubic prostatectomy. Materials and Methods: It was a retrospective review of data of patients that underwent open simple retropubic prostatectomy with technical modification of the trigone-bladder neck complex in two Nigerian tertiary hospitals, by a single surgeon, from January 2007 to December 2011. The data analysed included the demographic variables, the modes of presentation, need for blood transfusion, duration of catheterization and the duration of hospital stay. The primary end-point was the development or otherwise of BNS. Results: Eighty-seven patients' data were available for analysis from a total of 91 patients. The mean age (±standard deviation [SD]) was 65.14 years (±10.55). Preoperative urinary retention was present in 58% of the patients. The maximal flow rate (Qmax) was 12.05 ml/s among the 20 patients that had preoperative uroflowmetry. The transfusion rate was 35%, but almost two-third of them had only one unit of blood transfused. The mean weight (±SD) of the enucleated adenoma was 82.64 g (±36.63). Bladder irrigation was required in 14% of the patients, majority of the patients had urethral catheter removed after 96 h and the mean hospital stay was 6.52 days. No patient developed BNS after a mean follow-up duration of 16.39 months. Conclusion: Bladder neck stenosis can be a distressing complication of prostatectomy. The result of our technical modification of managing the trigone-bladder-neck complex looks promising for prevention or delaying the onset of BNS. A long-term observation and a prospective randomised control trial to ascertain this initial experience is needed.

Bladder calculi after radical prostatectomy is rare and usually associated with migrated clips into the bladder forming a nidus. We present a patient with multiple bladder calculi resulting from bladder neck stenosis after radical prostatectomy causing bothersome lower urinary tract symptoms. He had an associated hypertrophic scar. A 60-year-old man of African ancestry presented with recent onset of irritative urinary symptoms three years after radical prostatectomy. Abdomen pelvic ultrasound and pelvic X-ray revealed a urinary bladder calculus. Examination of the previous radical prostatectomy scar found him to have a hypertrophic scar. He had urethroscopy with bladder neck incision for bladder neck stenosis and cystolithotomy with resolution of the symptoms. The presentation was that of dysuria and frequency three years after radical prostatectomy. The cause of the symptoms was diagnosed after an abdomen pelvic ultrasound and pelvic X-ray as multiple bladder calculi. This is a rare finding with the few reported cases associated with clips that migrated to the urinary bladder forming a nidus for the calculi. This was of consideration in the case presented, however, the findings at urethroscopy revealed bladder neck stenosis suggesting stasis as possible cause of the bladder calculi. The symptoms resolved after bladder neck incision and cystolithotomy. In addition to clips forming a nidus for calculi in the urinary bladder after radical prostatectomy, bladder neck stenosis being the cause of urinary bladder calculi should be considered in a patient with hypertrophic scar. • Bladder calculi after radical prostatectomy is rare and usually associated with migrated clips into the bladder. • In patients with hypertrophic scars, there is the potential to form thick fibrosis at the reconstructed bladder neck • The resulting urinary stasis may lead to calculi formation in the urinary bladder. • Cystolithotomy, following bladder neck incision, preserves the integrity of the sphincter mechanism [ABSTRACT FROM AUTHOR]

ObjectivesThe objective of this study was to compare the recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral stenosis (VUS) after radical prostatectomy (RP) and for bladder neck stenosis (BNS) after transurethral resection of the prostate (TURP).MethodsRetrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups.ResultsA total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44–86), mean follow-up 27.1 months (1–98). Mean time to recurrence after initial therapy was 23.9 months (1–156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1–159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p = 0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; p = 0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p = 0.031). The mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p = 0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p = 0.091), whereas the rate of de novo incontinence (13.8 for VUS vs. 0% for BNS; p = 0.005) stayed significantly higher in patients treated for VUS.ConclusionMost patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to de novo incontinence. Patients must be counseled regarding the increased risk of de novo incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.

Purpose: To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the bladder neck in case of recurrent bladder neck stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. Patients and methods: We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients' charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Results: Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62-73) years. Most patients had BNS due to TUR-P [ n = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18-64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q , mean Q post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; ( t(5) = 4.12, p = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; ( t(9) = −3.86, p = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. Conclusions: The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging. [ABSTRACT FROM AUTHOR]

Objective: Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia (BPH) is a sparsely described complication. We describe management of five categories of these strictures in this retrospective observational case series., Methods: One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated. Among them, 76 were eligible for this study and underwent reconstructive surgery. Preoperative and postoperative assessments were done with symptom scores, uroflowmetry, ultrasound for post-void residue, and urethrogram. Any intervention during follow-up was classed as a failure. The recurrence and 95% confidence interval for recurrence percentage were calculated., Results: The following five categories of patients were identified: Bulbo-membranous (33 [43.4%]), navicular fossa (21 [27.6%]), penile/peno-bulbar (8 [10.5%]), bladder neck stenosis (6 [7.9%]), and multiple locations (8 [10.5%]). The average age was 69 years (range: 60-84 years). Overall average symptom score, flow rate, and post-void residue changed from 21 to 7, 6 mL/s to 19 mL/s, and 210 mL to 20 mL, respectively. The average follow-up was 34 months (range: 12-58 months). Overall recurrence and complication rates were 10.5% and 9.2%, respectively. The recurrence in each category was seen in 3, 1, 2, 1, and 1 patient, respectively. Overall 95% confidence interval for recurrence percentage was 4.66-19.69., Conclusion: Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH. The bulbo-membranous strictures need continence preserving approach. Navicular fossa strictures require minimally invasive and cosmetic consideration. Peno-bulbar strictures require judicious use of grafts and flaps. Bladder neck stenosis in this cohort could be treated with endoscopic measures. Multiple locations need treatment based on their sites in single-stage as far as possible., Competing Interests: The author declares no conflict of interest., (© 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Objective: To report the experience with our technical modification of the trigone-bladder neck complex management in the prevention of bladder neck stenosis (BNS) following open simple retropubic prostatectomy. Materials and Methods: It was a retrospective review of data of patients that underwent open simple retropubic prostatectomy with technical modification of the trigone-bladder neck complex in two Nigerian tertiary hospitals, by a single surgeon, from January 2007 to December 2011. The data analysed included the demographic variables, the modes of presentation, need for blood transfusion, duration of catheterization and the duration of hospital stay. The primary end-point was the development or otherwise of BNS. Results: Eighty-seven patients' data were available for analysis from a total of 91 patients. The mean age (±standard deviation [SD]) was 65.14 years (±10.55). Preoperative urinary retention was present in 58% of the patients. The maximal flow rate (Qmax) was 12.05 ml/s among the 20 patients that had preoperative uroflowmetry. The transfusion rate was 35%, but almost two-third of them had only one unit of blood transfused. The mean weight (±SD) of the enucleated adenoma was 82.64 g (±36.63). Bladder irrigation was required in 14% of the patients, majority of the patients had urethral catheter removed after 96 h and the mean hospital stay was 6.52 days. No patient developed BNS after a mean follow-up duration of 16.39 months. Conclusion: Bladder neck stenosis can be a distressing complication of prostatectomy. The result of our technical modification of managing the trigone-bladder-neck complex looks promising for prevention or delaying the onset of BNS. A long-term observation and a prospective randomised control trial to ascertain this initial experience is needed. [ABSTRACT FROM AUTHOR]

Bladder neck stenosis (BNS) and posterior urethral stenosis (PUS) are uncommon but problematic complications of treatment for localized prostate cancer. Overall, BNS is less common following minimally invasive radical prostatectomy than open. Patients who develop PUS following radiation therapy (RT) (especially salvage RT) pose a greater challenge and tend to present longer after treatment. Regardless of etiology, treatment begins conservatively with endoscopic management but quickly progresses to more aggressive intervention if refractory. Urethral stents have been used with acceptable results. In patients who fail conservative therapy after radical prostatectomy (RP), open reconstruction should be considered. After RT, patients may ultimately benefit from urinary diversion or salvage prostatectomy. After treatment, many patients will require implantation of artificial urinary sphincter (AUS) for management of incontinence. Patient counseling prior to treatment selection for initial prostate cancer therapy is important; complications, future management, and potential for return to normal quality of life vary widely. [ABSTRACT FROM AUTHOR]

Preliminary results of a case series on refractory bladder neck stenosis treated with laparoscopic T-plasty are presented in this article. This study retrospectively identified nine patients with refractory bladder neck stenosis aged 60 to 80 years between May 2016 and December 2017, who had undergone laparoscopic T-plasty. All patients presented voiding difficulty and failed after two or more prior endoscopic treatments. Laparoscopic T-plasty was performed by incising the anterior wall of the bladder neck in a T-shaped manner and creating two well-vascularized and tension-free flaps, which offer the possibility to reconstruct a wide bladder neck. After a mean follow-up of 14.7 months (ranging 3-22 months), a successful outcome was achieved in eight patients without incontinence secondary to surgery. Recurrent voiding difficulty developed in one patient, which was cured after a following endoscopic treatment. Through these nine patients, a preliminary conclusion can be drawn that a wider bladder neck can be obtained through modified YV-reconstruction of the bladder neck, while avoiding external urethral sphincter injury. And laparoscopic T-plasty has clear advantages compared with an open approach. It is an available and effective option for refractory bladder neck stenosis.

The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.