Laparoscopic modified Y-V plasty for recurrent bladder outlet obstruction induced by operation of benign prostatic hyperplasia

Abstract

Objective To investigate the clinical effect of laparoscopic modified bladder neck Y-V plasty in the treatment of recurrent bladder outlet obstruction after surgery for prostatic hyperplasia. Methods Seventeen patients with recurrent bladder outlet obstruction after prostatic hyperplasia operation from May 2017 to January 2019 was treated by laparoscopic bladder neck Y-V plasty, with the median age of 71 years old (65-81 years). All had a history of repeated urination obstruction and urinary tract infection, and experienced at least 2 times transurethral stenosis incision, resection or repeated urethral dilatation, with 12 cases of bladder neck stenosis ( typeⅠ) and 5 cases of middle prostate stenosis ( typeⅡ). Three-port laparoscopy surgery was performed with outer-peritoneal route into the Retzius Gap. After revealing the bladder and prostate junction, the Y incision of the bladder and stenosis of the prostate urethra was firstly performed, and inverted symmetrical V shape suture was performed with two 3-0 Stratifix suture for two layers, including the 1th layer suture of mucosal and inner muscle layer, and the 2nd layer suture of the outer muscle and the serous layer. F22 silicone catheter was indwelled for 2 weeks postoperatively. Urinary flow rate and bladder urethral examination were perfrmed to evaluate the effect of surgery 2 weeks and 3 months after the operation respectively. Results Seventeen operations were completed successfully, with the median operation time of 100 minutes (30-100 minutes), the median operation blood loss of 50 ml (20-100 ml), and the median hospital stay of 5 days (1-7 days). The patient had unobstructed voiding after removing the urinary catheter 2 weeks postoperatively, and had no urinary incontinence. Postoperative median follow-up was 7 months (3-17 months) and no stenosis of the urethra was detected. Conclusions Laparoscopic modified bladder neck Y-V Plasty has the advantages of high success rate, low recurrence rate and minimally invasiveness in the treatment of recurrent bladder outlet obstruction after prostatic hyperplasia surgery, which is worthy of clinical application. Key words: Bladder outlet obstruction; Prostatic hyperplasia; Modified bladder neck Y-V plasty; Laparoscopic surgical procedure