Abstract
Introduction:
Benign prostate hyperplasia (BPH) is a common disease among the elderly, which is the major cause of lower urinary tract symptoms. Transurethral resection of the prostate (TURP) is widely used for the treatment of BPH. However, complications of urethral stricture and bladder neck contracture (BNC) occur postoperation that causes poor quality of life in patients. Reported incidence of BNC ranges from 0.3% to 9.6%. 1,2 Bladder neck incision, laser vaporization, and balloon dilatation are applied for the treatment of BNC with overall high recurrence rates. In recent years, new techniques such as T-plasty, a modified YV-plasty, and robot-assisted laparoscopic Y-V plasty were performed in the treatment of BNC and achieved satisfactory outcomes with success rate of 83.3%–90%. 3,4 However, these techniques are complicated and difficult for the primary urologists to master. This video shows a transurethral approach by using a needle electrode to incise the pathway from the bladder outlet to the proximal verumontanum at 5, 7, and 12 o'clock positions, respectively, the depth of the incision should reach the adipose layer.
Materials and Methods:
From February 2015 to August 2019, the bladder necks from 48 patients with BNC after TURP were incised by the needle electrode at the 5, 7, and 12 o'clock positions, which extended the incision from the bladder outlet to the proximal verumontanum until exposure of the adipose layer. During the whole procedure in the treatment of BNC including cut of the residual prostate scar tissue, three-point incision by the needle electrode was the most important for the treatment of BNC, which could be against the formation of fibrous rings and prevent the recurrence of BNC. Patient's preoperation properties, peri- and postsurgical data, such as time of operative, postsurgical bladder irrigation, catheter duration, and hospital stay, as well as data of the international prostate symptom score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR), were recorded 1 and 6 months after surgery.
Results:
All 48 cases of BNC were effectively treated in (49.6 ± 14.4) minutes with (15.1 ± 4.6) hours for postoperative bladder irrigation. The urethral catheter was withdrawn at (5.6 ± 2.4) days post-treatment. Only one case had dysuria after postoperative catheter removal, the other 47 cases on re-examination after 1 and 6 months showed that IPSS and PVR were significantly decreased, but Qmax was increased when compared with preoperation (p < 0.001). Importantly, there were no significantly different outcomes between 1 and 6 months postoperation (p > 0.05). Strikingly, 20 cases followed up 6–24 months, mean of 12 months, had no urinary incontinence, retrograde ejaculation, and recurrence of BNC.
Conclusions:
Transurethral incision of bladder neck by the three-point method using the needle electrode for the treatment of BNC is mini-invasive, safe, effective, and reliable and may be implemented in the clinical setting.
No competing financial interests exist.
Runtime of video: 6 mins 53 secs
