95 DEEP TRANSURETHRAL INCISION ALONE FOR REFRACTORY BLADDER NECK CONTRACTURE WITH OR WITHOUT STRESS URINARY INCONTINENCE: IS INJECTION THERAPY NECESSARY?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (II)1 Apr 201395 DEEP TRANSURETHRAL INCISION ALONE FOR REFRACTORY BLADDER NECK CONTRACTURE WITH OR WITHOUT STRESS URINARY INCONTINENCE: IS INJECTION THERAPY NECESSARY? Daniel Ramirez, Aditya Bagrodia, Steven J. Hudak, Lee C. Zhao, and Allen F. Morey Daniel RamirezDaniel Ramirez Dallas, TX More articles by this author , Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Steven J. HudakSteven J. Hudak Dallas, TX More articles by this author , Lee C. ZhaoLee C. Zhao Dallas, TX More articles by this author , and Allen F. MoreyAllen F. Morey Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1473AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Injection of mitomycin C during transurethral incision of recurrent bladder neck contracture (RBNC) has been reported to produce a 72% success rate after one treatment (J Urol 186; 156-160, 2011). We evaluated results of deep transurethral incision of bladder neck contracture (TUIBNC) alone and identified risk factors associated with RBNC. For patients with concomitant stress urinary incontinence (SUI), we assessed timing between TUIBNC and placement of a subsequent artificial urinary sphincter (AUS). METHODS We reviewed 50 consecutive men undergoing standardized deep TUIBNC from 2007 to 2012. TUIBNC involved dilation with a 4 cm X 24 Fr balloon followed by deep transurethral incisions at 3 and 9 o'clock with a Collings knife. No urethral injections of any kind were performed. We examined patient records for smoking history, radiation, diabetes, previous TUIBNC, and prostate surgery. We reviewed failure rates, time to AUS placement, need for AUS revision, and recurrence of BNC after AUS. Univariate analysis was performed to identify risk factors for RBNC. RESULTS Of the 50 patients studied, 80% had failed previous BNC procedures. After deep TUIBNC, 72% required no further surgery for obstruction at a mean follow-up of 12.9 months. Of the 14 patients who failed initial TUIBNC, 7 underwent repeat TUIBNC with success. Patients most likely to fail initial deep TUIBNC were those having two or more prior BNC procedures or ≥10 pack/year smoking history [failure rates 40.7% (P = 0.03) and 71.4% (P = 0.04), respectively]. A total of 39 men (78%) presented with concomitant SUI; two-thirds of these underwent AUS placement after an average of 2.9 months following TUIBNC. SUI occurred de novo after TUIBNC in 1 /11 (9%) patients. Only 2/26 patients required repeat transurethral procedures after AUS placement for recurrent BNC. CONCLUSIONS Deep lateral TUIBNC alone is a highly effective treatment modality for RBNC, and produces results comparable to those reported after mitomycin C injection. The majority of men with RBNC can be stabilized with deep lateral TUIBNC alone, although smokers and those having 2 or more prior RBNC procedures are at greater risk for failure. Subsequent AUS placement can be safely performed after a 3-month rest period with > 90% urethral patency rate. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e38-e39 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Ramirez Dallas, TX More articles by this author Aditya Bagrodia Dallas, TX More articles by this author Steven J. Hudak Dallas, TX More articles by this author Lee C. Zhao Dallas, TX More articles by this author Allen F. Morey Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...