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01-12-2024 | Transurethral Prostate Resection | Original Article

Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study

Authors: Meng-Hua Wu, Jia-Xin Liu, Yu-Feng Zhang, Zi-Bing Cao, Hong-Chen Song, Bo-Yu Yang, Ming-Jun Shi, Yuan Du, Jian Song, Xuan-Hao Li

Published in: World Journal of Urology | Issue 1/2024

Abstract

Purpose

Bladder neck contracture (BNC) is a rare but intolerant complication after transurethral surgery of prostate. The present study aims to investigate the incidence and risk factors of BNC in patients diagnosed benign prostate hyperplasia (BPH) and following transurethral resection or enucleation of the prostate (TURP/TUEP).

Methods

This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients’ demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors.

Results

A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8 months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8 months, 35% (7/20) of BNC patients recurred at a median time of 1.8 months.

Conclusion

BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.

Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109CrossRefPubMed

Launer BM, McVary KT, Ricke WA, Lloyd GL (2021) The rising worldwide impact of benign prostatic hyperplasia. BJU Int 127(6):722–728CrossRef

Cornu J-N, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096CrossRef

Zhang Y, Yuan P, Ma D, Gao X, Wei C, Liu Z, Li R, Wang S, Liu J, Liu X (2019) Efficacy and safety of enucleation vs. resection of prostate for treatment of benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis 22(4):493–508CrossRef

Al-Rawashdah SF, Pastore AL, Salhi YA, Fuschi A, Petrozza V, Maurizi A, Illiano E, Costantini E, Palleschi G, Carbone A (2017) Prospective randomized study comparing monopolar with bipolar transurethral resection of prostate in benign prostatic obstruction: 36-month outcomes. World J Urol 35(10):1595–1601CrossRefPubMed

Lusuardi L, Mitterberger M, Hruby S, Kunit T, Kloss B, Engelhardt PF, Sieberer M, Janetschek G (2015) Update on the use of diode laser in the management of benign prostate obstruction in 2014. World J Urol 33(4):555–562CrossRefPubMed

Franz J, Suarez-Ibarrola R, Pütz P, Sigle A, Lusuardi L, Netsch C, Lehrich K, Herrmann TRW, Gratzke C, Miernik A (2022) Morcellation after endoscopic enucleation of the prostate: efficiency and safety of currently available devices. Eur Urol Focus 8(2):532–544CrossRef

Ayoub CH, Haber R, Amine R, Mikati D, Mahfoud ZR, El Hajj A, (2023): Comparison of postoperative outcomes of trans-urethral resection of the prostate, laser vaporization, and laser enucleation: a double propensity score matched analysis. Urology: S0090–4295(0023)00393-X.

Chen Y-Z, Lin W-R, Chow Y-C, Tsai W-K, Chen M, Chiu AW (2021) Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate. BMC Urol 21(1):59CrossRefPubMedPubMedCentral

10.

Primiceri G, Castellan P, Marchioni M, Schips L, Cindolo L (2017) Bladder neck contracture after endoscopic surgery for benign prostatic obstruction: incidence, treatment, and outcomes. Curr Urol Rep 18(10):79CrossRefPubMed

11.

Tao H, Jiang YY, Jun Q, Ding X, Jian DL, Jie D, Ping ZY (2016) Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate. Int Braz J Urol 42(2):302–311CrossRefPubMedCentral

12.

Henderson NC, Rieder F, Wynn TA (2020) Fibrosis: from mechanisms to medicines. Nature 587(7835):555–566CrossRefPubMedCentral

13.

Bochaton-Piallat M-L, Gabbiani G, Hinz B, (2016): The myofibroblast in wound healing and fibrosis: answered and unanswered questions. F1000Res, 5:F1000 Faculty Rev-1752.

14.

Doluoglu OG, Gokkaya CS, Aktas BK, Oztekin CV, Bulut S, Memis A, Cetinkaya M (2012) Impact of asymptomatic prostatitis on re-operations due to urethral stricture or bladder neck contracture developed after TUR-P. Int Urol Nephrol 44(4):1085–1090CrossRefPubMed

15.

Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397CrossRef

16.

Xie JB, Tan YA, Fl W, Xuan Q, Sun YW, Xiao J, Zhu YP, Zhou LY (2014) Extraperitoneal laparoscopic adenomectomy (Madigan) versus bipolar transurethral resection of the prostate for benign prostatic hyperplasia greater than 80 ml complications and functional outcomes after 3-year follow-up. J Endourol 28(3):353–359CrossRefPubMed

17.

Lee YH, Chiu AW, Huang JK (2005) Comprehensive study of bladder neck contracture after transurethral resection of prostate. Urology 65(3):1CrossRef

18.

Naspro R, Gomez Sancha F, Manica M, Meneghini A, Ahyai S, Aho T, Fiori C, Vavassori I, Da Pozzo LF, Pansadoro V et al (2017) From “gold standard” resection to reproducible “future standard” endoscopic enucleation of the prostate: what we know about anatomical enucleation. Minerva Urol Nefrol 69(5):446–458PubMed

19.

Chen Y-H, Li X-D, Ke Z-B, Chen J-Y, Lin T, Lin T-T, Zhu J-M, Zheng Q-S, Xue X-Y, Wei Y et al (2023) Risk factors for the postoperative bladder neck contracture in patients with small-volume prostatic hyperplasia. Asian J Surg 46(1):373–379CrossRefPubMed

20.

Bochaton-Piallat M-L, Gabbiani G, Hinz B, (2016): The myofibroblast in wound healing and fibrosis: answered and unanswered questions. F1000Res, 5.

21.

Powell CR, Kreder KJ (2009) Treatment of bladder diverticula, impaired detrusor contractility, and low bladder compliance. Urol Clin North Am 36(4):511–525CrossRef

22.

Sun Q, Guo W, Cui D, Wang X, Ruan Y, Zhao F, Xia S, Han B, Jing Y (2019) Thulium laser enucleation versus thulium laser resection of the prostate for prevention of bladder neck contracture in a small prostate: a prospective randomized trial. World J Urol 37(5):853–859CrossRefPubMed

23.

Nealon SW, Bhanvadia RR, Badkhshan S, Sanders SC, Hudak SJ, Morey AF (2022) Transurethral incisions for bladder neck contracture: comparable results without intralesional injections. J Clin Med 11(15):4355CrossRefPubMedPubMedCentral

24.

Giannarini G, Manassero F, Mogorovich A, Valent F, De Maria M, Pistolesi D, De Antoni P, Selli C (2008) Cold-knife incision of anastomotic strictures after radical retropubic prostatectomy with bladder neck preservation: efficacy and impact on urinary continence status. Eur Urol 54(3):647–656CrossRefPubMed

25.

Altay B, Erkurt B, Kiremit MC, Guzelburc V, Boz MY, Albayrak S (2015) 180-W XPS GreenLight laser vaporization for benign prostate hyperplasia: 12-month safety and efficacy results for glands larger than 80 mL. Lasers Med Sci 30(1):317–323CrossRef

26.

Redshaw JD, Broghammer JA, Smith TG, Voelzke BB, Erickson BA, McClung CD, Elliott SP, Alsikafi NF, Presson AP, Aberger ME et al (2015) Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS Study Group. J Urol 193(2):587–592CrossRef

27.

Farrell MR, Sherer BA, Levine LA (2015) Visual internal urethrotomy with intralesional mitomycin C and short-term clean intermittent catheterization for the management of recurrent urethral strictures and bladder neck contractures. Urology 85(6):1494–1499CrossRefPubMed

Title: Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study
Authors: Meng-Hua Wu
Jia-Xin Liu
Yu-Feng Zhang
Zi-Bing Cao
Hong-Chen Song
Bo-Yu Yang
Ming-Jun Shi
Yuan Du
Jian Song
Xuan-Hao Li
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Transurethral Prostate Resection
Urinary Tract Infection
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04715-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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