Transurethral incision of the bladder neck in recurrent bladder neck stenosis

Abstract

BACKGROUND: Transurethral incision of the bladder neck is one of the main methods of correction of bladder neck stenosis that occurred after treatment of patients with benign prostatic hyperplasia. This technique involves endoscopic dissection in the area of the stenosed area without removing scar tissue. Taking into account the emergence of new reconstructive methods of surgical intervention in patients with recurrent bladder neck stenosis the expediency of using transurethral incision of the bladder neck in recurrent cases remains a subject of discussion.
 AIM: The aim of the study is to evaluate the effectiveness of the use of transurethral incision of the bladder neck in patients with recurrent bladder neck stenosis.
 MATERIALS AND METHODS: The study included 30 patients with a diagnosis of recurrent bladder neck stenosis who were treated in the period from 2012 to 2022. in Clinical Hospital of St. Luke and was performed transurethral incision of the bladder neck using bipolar electrosurgical energy. The diagnosis of bladder neck stenosis was established on the basis of complaints, anamnesis, uroflowmetry with determination of the volume of residual urine, ureteroscopy, retrograde urethrography. Recurrence was recorded when the maximum urination rate below 12 ml/s, there was an episode of acute urinary retention, or the need for additional surgical intervention for bladder outlet obstruction.
 RESULTS: All 30 patients underwent transurethral incision of the bladder neck using bipolar electrosurgical energy. The average duration of surgery was 22.9 minutes. The degree of postoperative complications did not exceed grade II according to the Clavien scale. The frequency of de novo stress urinary incontinence was detected only in one patient, which resolved spontaneously within 6 weeks. The maximum urination rate after 3 months was 14.73 3.61 ml/s, while after 6 months there was a significant decrease to 10.91 6.92 ml/s, and after 12 months to 9.4 7, 65 ml/s. The absence of recurrence in patients after TUI BN during the observation period was noted in 17 (56.67%) patients.
 CONCLUSIONS: Transurethral incision of the bladder neck using a bipolar electrode is a safe method for correcting bladder neck stenosis, but in recurrent cases it has limited efficacy. In this regard, in patients with a large number of endoscopic interventions in history, other methods of bladder neck reconstruction should be chosen.