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Transurethral Incisions for Bladder Neck Contracture: Comparable Results without Intralesional Injections.

Samantha W Nealon1, Raj R Bhanvadia1, Shervin Badkhshan1

  • 1Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.

Journal of Clinical Medicine
|August 12, 2022
PubMed
Summary

This study shows that transurethral incision of bladder neck contracture (BNC) without injections is effective, achieving 82.1% success after one procedure. Multiple prior treatments predict failure in managing BNC.

Keywords:
adjunctive intralesional injectionsartificial urinary sphincterballoon dilationtransurethral incision of bladder neck contracture

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Area of Science:

  • Urology
  • Endourology
  • Surgical Management

Background:

  • Bladder neck contracture (BNC) is a challenging complication, often following prostatectomy or radiation.
  • Previous endoscopic treatments for BNC have varied success rates, with some utilizing intralesional agents.

Purpose of the Study:

  • To evaluate the 12-year experience with a specific endoscopic approach for BNC management.
  • To compare outcomes of this technique without intralesional agents to published data.

Main Methods:

  • Retrospective review of 123 patients treated for BNC between 2008 and 2020.
  • All patients underwent balloon dilation followed by transurethral incision of BNC (TUIBNC) with deep bilateral incisions.
  • No intralesional injections were used; success defined by bladder neck patency and cystoscope passage.

Main Results:

  • High success rates were achieved: 82.1% after one TUIBNC and 94.3% after two TUIBNCs.
  • The most common etiologies were post-radical prostatectomy and post-radiation.
  • Recurrent BNC often required repeat TUIBNC procedures.

Conclusions:

  • Transurethral incision of BNC (TUIBNC) using balloon dilation and deep bilateral incisions, without intralesional injections, demonstrates high efficacy.
  • A history of two or more prior endoscopic treatments is the sole predictor of treatment failure.