Salvage surgery for bladder outlet obstruction after prostatectomy or cystectomy

Area of Science:

• Urology
• Reconstructive Surgery
• Lower Urinary Tract Function

Background:

• Bladder neck contracture post-prostatectomy or cystectomy poses a significant reconstructive challenge.
• While urethral dilation and internal urethrotomy are initial treatments, recurrent obstruction necessitates advanced techniques.
• Differentiating stricture from dysfunctional voiding is crucial in post-cystectomy patients.

Purpose of the Study:

• To review current reconstructive strategies for bladder neck obstruction.
• To evaluate options for restoring lower urinary tract function after prostatectomy or cystectomy.
• To discuss management of recurrent strictures and associated incontinence.

Main Methods:

• Review of literature on bladder neck reconstruction techniques.
• Analysis of outcomes for urethral stent placement and anastomotic urethroplasty.
• Evaluation of strategies for achieving continence and managing unreconstructable cases.

Main Results:

• Aggressive electrocautery with urethral stenting and anastomotic urethroplasty are effective for bladder neck patency.
• Artificial urinary sphincters are a secondary option for continence post-stabilization.
• Catheterizable limbs or augmentation cystoplasty offer solutions for unreconstructable urethras or storage issues.

Conclusions:

• Recurrent obstruction rates are comparable between urethral stent placement and anastomotic urethroplasty.
• A high rate of incontinence should be anticipated following these reconstructive procedures.
• Incontinence must be considered in the overall treatment plan for bladder neck obstruction.