91 THE SURGICAL CORRECTION OF BLADDER NECK CONTRACTURE (BNC) FOLLOWING THE TREATMENT OF PROSTATE CANCER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 201291 THE SURGICAL CORRECTION OF BLADDER NECK CONTRACTURE (BNC) FOLLOWING THE TREATMENT OF PROSTATE CANCER Anthony Mundy and Daniela Andrich Anthony MundyAnthony Mundy London, United Kingdom More articles by this author and Daniela AndrichDaniela Andrich London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The majority of patients with BNC following surgery or radiotherapy for prostate cancer can be treated endoscopically but this is not always successful. On the other hand surgical correction is rarely reported, indeed only 24 cases have been described in the English literature. Herein we describe our experience with 32 patients and distinguish between BNC due to surgery and BNC due to radiotherapy. METHODS Group 1: 17 patients with BNC following radical retropubic prostatectomy (RRP). Group 2: 6 patients with BNC following RRP plus salvage external beam radiotherapy (EBRT). Group 3: 9 patients with BNC following EBRT with or without other salvage treatment with either brachytherapy or HIFU. All patients had failed to respond to several attempts at urethrotomy, bladder neck incision and/or bladder neck resection. Patients in group 1 and 2 were treated by transperineal excision of their BNC and re-do vesico-urethral anastomosis (VUA). Patients in Group 3 underwent salvage RRP. RESULTS Two of the 17 patients in Group 1 developed a recurrent BNC which was successfully dealt with by a further redo-VUA so that ultimately all 17 were cured of their BNC. Two of the 6 patients in Group 2 developed a recurrent BNC and were managed with a long term suprapubic catheter (SPC). Of the 21/23 success in Groups 1 and 2, all 21 needed implantation of an AUS to restore continence. Six of the 9 patients in Group 3 had successful correction of their BNC one of whom needed an AUS to restore continence. The 3 failures in Group 3 were managed by a long-term SPC. In the patients who had had EBRT, surgery was technically more challenging, the post-operative recovery was more protracted and the outcome was less satisfactory. CONCLUSIONS Re-do VUA is a very successful management of patients with refractory post-surgical BNC but all patients require an AUS so treatment is a two-stage process. After irradiation, surgery is significantly more complicated and the outcome less satisfactory but nonetheless successful in the majority. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e38 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Mundy London, United Kingdom More articles by this author Daniela Andrich London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...