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Purpose: We aimed to evaluate the predictive clinical and operative risk factors for urinary incontinence (UI) rates following thulium fiber enucleation of benign prostate hyperplasia (ThuFLEP). Materials and methods: We conducted a retrospective cohort review of a prospectively maintained database for patients who underwent ThuFLEP between 2021 and 2023 in our university clinic performed by a single surgeon with high experience (more than 3000 endoscopic enucleation). To perform the operation, we used a thulium fiber laser Fiberlase U3 (IRE Polus ltd, Fryazino, Russia) with operating modes of 1.5 J and 40 Hz 60 W. Postoperative UI rates and risk factors following ThuFLEP were assessed for three follow-up intervals (up to 1 months, from 1 to 3 months and after 3 months post-ThuFLEP). Statistical analysis was conducted using univariate and multivariate logistic regression. Results: Out of total 578 patients who underwent ThuFLEP, the study included 381 patients with full information about continence status. Long-term UI (more than 3 months) were found only in 1.6% cases with 0.8% for stress UI, 0.3% for urge UI and 0.5% for mixed UI. Univariate logistic regression analysis has shown that higher total laser energy (OR = 1.009; 95% CI = 1.001–1.018; p = 0.036) and enucleation technique (OR = 0.272; 95% CI = 0.113–0.656; p = 0.004 in favor of En-bloc ThuFLEP) were associated with UI overall, while at multivariable analysis only En-bloc ThuFLEP was protective factor for UI (OR = 0.302; 95%CI = 0.123–0.739; p = 0.009). For short-term UI (less than 1 months) early sphincter release was found as protective factor at both uni- and multivariate analysis compare to longer UI. Conclusion: Short-term UI up to 3 months following ThuFLEP is associated with early sphincter release, while overall UI rates are related with enucleation technique (preferable En-bloc) and total laser energy (preferable lower energy). The surgeon should take all these risk factors into account before choosing the technique of BPH surgical treatment. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to assess the results of balloon dilation in patients with bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH). Materials and Methods: The study involved 120 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent transurethral resection (TUR) of the bladder neck and were divided into two groups: Group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, whereas the control group B (n = 75) included men who were treated with alpha-blockers alone. Results: In 9 months after TUR and 3 months after the 4th balloon dilation procedure in Group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life was 4.2 ± 1.2 (P > 0.05). In Group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (P > 0.05), respectively. In addition, the mean flow rate in Group A was 13.2 ± 5.4 ml/s, whereas in Group B, it was 8.7 ± 4.9 ml/s (P < 0.05). There was a significant decrease in the postvoid residual urine volume from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in Group A, whereas, in Group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (P > 0.05). Furthermore, 28.0% of patients of Group B and 13.3% of patients of Group A underwent repeated TUR of the bladder neck in 9 months follow-up period (P < 0.05). Conclusion: Balloon dilation is a safe less invasive procedure and can reduce the possibility of BNC recurrence and thus the rate of repeated transurethral interventions. [ABSTRACT FROM AUTHOR]

Bladder neck contracture (BNC) is one of the most common complications of surgical treatment of prostate diseases. The rate of postoperative BNC varies depending on the type of surgical treatment used. The options for treatment techniques for BNC can vary from endoscopic interventions to complex (abdominal) surgical interventions. This review evaluates various alternative surgical methods of BNC treatment. The search and analysis of publications in the databases PubMed (MEDLINE), Scopus, Cochrane Library, according to the keywords, "bladder neck sclerosis," "benign prostatic hyperplasia," "BNC," "bladder neck stenosis," "balloon dilation," "treatment." As a result, 71 publications were selected and included in this review. In addition to the standard treatment methods in the form of transurethral resection and incision of the bladder neck using electricity and laser energy, the urologist also has alternative methods of treatment, such as balloon dilation, placement of urethral stents, instillation of the bladder or intraoperative injection of cytostatic drugs, hormones, hyaluronic acid derivatives, and biomedical cell products into the bladder neck area. Although transurethral resection is currently the main treatment option for BNC, the recurrence rate after this procedure can reach up to 38%. According to the literature, balloon dilation can be a promising and minimally invasive method of treatment for recurrent BNC. This method can be used as the first stage in the treatment of recurrent contracture deformity. Furthermore, intravesical instillation of various anti-inflammatory drugs and cytostatics can be promising directions in the treatment and prevention of BNC. [ABSTRACT FROM AUTHOR]