Synchronous Bladder Neck Contracture Dilation at the Time of Artificial Urinary Sphincter Placement Is Safe and Effective

Abstract

To treat men with bladder neck contracture and stress urinary incontinence, neither long-term nor comparative data exist to support the superiority of simultaneous bladder neck contracture intervention at the time of artificial urinary sphincter placement (synchronous) or staged bladder neck contracture intervention followed by artificial urinary sphincter placement (asynchronous). This study aimed to compare outcomes of patients treated with synchronous and asynchronous protocols. Using a prospectively maintained quality improvement database, we identified all men between the years of 2001-2021 with a history of bladder neck contracture and artificial urinary sphincter placement. Baseline patient characteristics and outcome measures were collected. Categorical data was assessed with Pearson's Chi-square and continuous data was assessed using independent sample t-tests or Wilcoxon Rank-Sum test. In total, 112 men met inclusion criteria. Thirty-two patients were treated synchronously and 80 were treated asynchronously. There were no significant differences between groups across 15 relevant variables. Overall follow-up duration was 7.1 (2.8,13.1) years. Three (9.3%) in the synchronous group and 13 (16.2%) in the asynchronous group experienced an erosion. There were no significant differences in frequency of erosion, time to erosion, artificial sphincter revision, time to revision, or bladder neck contracture recurrence. Bladder neck contracture recurrences after artificial sphincter placement were treated with serial dilation with no early device failure or erosion. Similar outcomes are achieved following synchronous and asynchronous treatment of bladder neck contracture and stress urinary incontinence. Synchronous approaches should be considered safe and effective for men with stress urinary incontinence and bladder neck contracture.