One-Year Outcomes of Transurethral Treatment of Bladder Neck Stenosis Following Transurethral Resection of the Prostate. Results from a Large, Multicenter Series

Daniele Castellani; Silvia Stramucci; Bhavatej Enganti; Jenni Lane; Santosh Kumar; Yiloren Tanidir; Alba Farré; Boyke Soebhali; Vigen Malkhasyan; Nariman Gadzhiev; Marek Adam Zawadzki; Pankaj Nandkishore Maheshwari; Khi Yung Fong; Giacomo Maria Pirola; Angelo Naselli; Apurva Anand; Shreyas K Bhadranavar; Bhaskar K Somani; Andrea Benedetto Galosi; Vineet Gauhar

doi:10.2147/IJGM.S459441

One-Year Outcomes of Transurethral Treatment of Bladder Neck Stenosis Following Transurethral Resection of the Prostate. Results from a Large, Multicenter Series

Int J Gen Med. 2024 May 7:17:1967-1974. doi: 10.2147/IJGM.S459441. eCollection 2024.

Authors

Daniele Castellani¹, Silvia Stramucci¹, Bhavatej Enganti², Jenni Lane³, Santosh Kumar⁴, Yiloren Tanidir⁵, Alba Farré⁶, Boyke Soebhali⁷, Vigen Malkhasyan⁸, Nariman Gadzhiev⁹, Marek Adam Zawadzki¹⁰, Pankaj Nandkishore Maheshwari¹¹, Khi Yung Fong¹², Giacomo Maria Pirola¹³, Angelo Naselli¹³, Apurva Anand¹⁴, Shreyas K Bhadranavar¹⁴, Bhaskar K Somani³, Andrea Benedetto Galosi¹, Vineet Gauhar¹⁵

Affiliations

¹ Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
² Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India.
³ Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
⁴ Department Urology, Christian Medical College, Vellore, India.
⁵ Unit of Urology, Marmara University, Pendik Research and Education Hospital, Istanbul.
⁶ Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
⁷ Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Mulawarman University, Samarinda, Indonesia.
⁸ Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation.
⁹ Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation.
¹⁰ Urology Unit, St. Anna Hospital, Piaseczno, Poland.
¹¹ Department of Urology, Fortis Hospital Mulund, Mumbai, India.
¹² Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹³ Urology Unit, San Giuseppe Hospital, Multimedica Group, Milan, Italy.
¹⁴ Urology Unit, Kulkarni Reconstructive Urology Center, Pune, India.
¹⁵ Department of Urology, Ng Teng Fong Hospital, NUHS, Singapore, Singapore.

Abstract

Purpose: To assess management and outcomes of bladder neck stenosis (BNS) post-transurethral resection of the prostate (TURP) in 12 centers.

Patients and methods: A retrospective analysis of patients who underwent transurethral BN incision for stenosis following TURP from January 2015 and January 2023 was performed. Inclusion criteria included endoscopic diagnosis of BNS associated with obstruction and/or lower urinary tract symptoms. Data are presented as median and interquartile range. Two distinct univariable logistic regression analyses were performed to identify factors associated with overall urinary incontinence and recurrent stenosis.

Results: Three hundred and seventy-two men were included. 95.2% of patients developed BNS following bipolar TURP. 21.0% of patients were on an indwelling catheter before BNS incision. Bipolar electrocautery was the most commonly employed energy for incision (66.5%). Collings knife was the most commonly employed (61.2%) instrument for incision, followed by end-firing holmium lasering (35.3%). Median operation time was 30 (25-45) minutes. The overall complication rate was 12.4%, with 19 (5.1%) patients suffering from acute urinary retention, 6 (1.6%) patients requiring prolonged irrigation due to persistent hematuria, and a surgical hemostasis was necessary in 8 cases (2.2%). Overall postoperative incontinence rate was 17.2%, with urge incontinence accounting for the most common type (45.3%). Incontinence lasted more than 3 months in 9/46 (14.3%) patients. Recurrent BNS occurred in 29 (7.8%) patients and was managed by re-endoscopic incision in 21 (5.6%) patients and dilatation only in 6 (1.6%) patients. Two (0.5%) patients underwent urethroplasty for recalcitrant stenosis. Logistic regression analysis showed that Collings knife was associated with higher odds of having postoperative incontinence (OR 3.93 95% CI 1.45-11.13, p=0.008) and BN recurrence (OR 3.589 95% CI 1.157-15.7, p=0.047).

Conclusion: Transurethral BN incision provides satisfactory short-term results with an acceptable rate of complications.

Keywords: bladder neck stenosis; postoperative complications; transurethral resection of the prostate; urinary incontinence.