Bladder Neck Stenosis Research Articles

V08-08 ROBOTIC EXTRAPERITONEAL EXTRAVESICAL PROSTATE ADENOMECTOMY WITH RUNNING SUTURE OF THE BLADDER NECK ONTO THE INTRAPROSTATIC URETHRA

You have accessJournal of UrologyBPH & Bladder Outlet Obstruction (V08)1 Apr 2020V08-08 ROBOTIC EXTRAPERITONEAL EXTRAVESICAL PROSTATE ADENOMECTOMY WITH RUNNING SUTURE OF THE BLADDER NECK ONTO THE INTRAPROSTATIC URETHRA Mustafa Tutal*, Christian Padevit, Beat Foerster, Anja Sauck, Christoph Schregel, Kevin Horton, and Hubert John Mustafa Tutal*Mustafa Tutal* More articles by this author , Christian PadevitChristian Padevit More articles by this author , Beat FoersterBeat Foerster More articles by this author , Anja SauckAnja Sauck More articles by this author , Christoph SchregelChristoph Schregel More articles by this author , Kevin HortonKevin Horton More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000909.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic prostate adenomectomy was first reported by Sotelo et al. in transperitoneal and by John et al. in extraperitoneal approach. Meanwhile simple robotic prostatectomies have been modified with transperitoneal or extraperitoneal access using transvesical or extravesical enucleation techniques. We demonstrate our routinely preferred technique with extraperitoneal approach, extravesical prostate adenomectomy and bladder neck reconstruction by running suture of the bladder neck with the intraprostatic urethra. METHODS: Standardized extraperitoneal access is performed with balloon dilatation and placement of a 4-arm daVinci Xi® System under visual control of the instrument tips. The Santorini Plexus is ligated with 3-0 Monocryl to prevent back flow bleeding. The bladder neck is prepared and dissected around the indwelling catheter. Depending on the position of the ureteral orifices, ureteral stents are placed to exclude postoperative ureteral obstruction. The enucleation of the prostate gland is performed with blunt dissection and visually controlled bipolar coagulation of penetrating vessels from the prostate capsule. Preliminary dorsal fixation of the bladder neck to the posterior prostate capsule is performed with 4-0 Stratafix® barbed suture to prevent further tension and additionally minimize capsular bleeding. Thereafter, the urethral tract is reconstructed by direct continuous double armed suture 4-0 Stratafix® according to van Velthoven of the bladder neck with the intraprostatic urethral stump - thereby excluding the prostatic fossa totally. If necessary longitudinal running suture of the ventral bladder neck closes the urinary bladder and patency is tested. The prostate capsule is adapted onto the ventral bladder wall. A suprapubic catheter is placed, the specimen removed and a drain placed between the anterior bladder wall and prostate capsule according to surgeon preference. RESULTS: No irrigation is needed, the indwelling catheter is removed after 24h-48h and the patient discharged after 2-3 days. Cystography excludes urinary leak after 5 days. CONCLUSIONS: This extraperitoneal extravesical robotic adenomectomy provides a minimal invasive procedure in large BPH, thus avoiding significant blood loss, postoperative bleeding, infections and urgencies associated with the enucleated fossa, bladder neck stenosis and urethral injury. The demonstrated operative technique has become our standard after development of our Millin program over 10 years and more than 60 cases. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e737-e737 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mustafa Tutal* More articles by this author Christian Padevit More articles by this author Beat Foerster More articles by this author Anja Sauck More articles by this author Christoph Schregel More articles by this author Kevin Horton More articles by this author Hubert John More articles by this author Expand All Advertisement PDF downloadLoading ...

Anastomosis stenosis after radical prostatectomy and bladder neck stenosis after benign prostate hyperplasia treatment: reconstructive options

Bladder neck stenosis (BNS) after simple prostatectomy and vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy for prostate cancer are common sequelae. However, the two entities differ in their pathology, anatomy and their surgical results. VUAS has an incidence of 0.2-28%. Commonly, VUAS occurs within the first 2years after surgery. Initial therapy should be performed endourologically: dilatation, (laser) incision or resection. After three unsuccessful treatment attempts, open reconstruction should be considered. Different surgical approaches (abdominal, perineal, abdominoperineal) have been described. All are associated with good success rates. However, they are accompanied by high rates of urinary incontinence. Incontinence can be treated safely by implantation of an artificial urinary sphincter. The incidence of BNS is around 5% for all types of surgery for benign prostate hyperplasia. It occurs within the first 2years after surgery. Initial treatment should be performed endourologically. In case of recalcitrant BNS, open reconstruction is indicated. The YV-plasty is an established procedure, and the T‑plasty represents amodification. Success rates of both procedures are high. Robot-assisted reconstructive procedures have been described for both VUAS and BNS.

Two methods in bladder neck stenosis treatment efficiency: Holmium YAG laser and cold blade incision

Two methods in bladder neck stenosis treatment efficiency: Holmium YAG laser and cold blade incision

PE09 - Management of intractable bladder neck strictures following radical prostatectomy

INTRODUCTION AND OBJECTIVE:The incidence of Vesicourethral Anastomotic Stenosis (VUAS) post radical prostatectomy varies from 1% to 26%. Current treatment can be challenging and include a variety o...

Laparoscopic T-Plasty for the Treatment of Refractory Bladder Neck Stenosis.

Preliminary results of a case series on refractory bladder neck stenosis treated with laparoscopic T-plasty are presented in this article. This study retrospectively identified nine patients with refractory bladder neck stenosis aged 60 to 80 years between May 2016 and December 2017, who had undergone laparoscopic T-plasty. All patients presented voiding difficulty and failed after two or more prior endoscopic treatments. Laparoscopic T-plasty was performed by incising the anterior wall of the bladder neck in a T-shaped manner and creating two well-vascularized and tension-free flaps, which offer the possibility to reconstruct a wide bladder neck. After a mean follow-up of 14.7 months (ranging 3–22 months), a successful outcome was achieved in eight patients without incontinence secondary to surgery. Recurrent voiding difficulty developed in one patient, which was cured after a following endoscopic treatment. Through these nine patients, a preliminary conclusion can be drawn that a wider bladder neck can be obtained through modified YV-reconstruction of the bladder neck, while avoiding external urethral sphincter injury. And laparoscopic T-plasty has clear advantages compared with an open approach. It is an available and effective option for refractory bladder neck stenosis.

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

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

Internal optical urethrotomy is the treatment of choice in stenosis of the bladder neck after open prostate adenectomy.

IntroductionOpen adenomectomy of the prostate, although performed less frequently, is still indicated in patients with prostate adenoma > 100 ml.AimThis study assessed the frequency of isolated bladder neck stenosis after surgery and the effectiveness of internal optical urethrotomy as monotherapy and in combination with transurethral resection in the treatment of this complication.Material and methodsOne thousand five hundred thirty-eight Millin’s operations and 381 trans-vesical adenomectomies were performed in patients with prostate adenoma. In 50 patients, the circular hemostatic suture was applied using the de la Peña technique because of bleeding after surgery. The retrospective analysis compared the incidence of isolated bladder neck stenosis depending on the type of surgery.ResultsIsolated bladder neck stenosis or narrowing of the neck combined with partial stenosis of the site after adenomectomy occurred in 0.52% (8/1539) of patients after Millin’s operation and in 1.05% of patients (4/381) after trans-vesical adenomectomy. All strictures of the bladder after trans-vesical surgery occurred within 12 month after the procedure, and 25% of stenoses after Millin’s operation occurred many years after the surgery. Internal optical urethrotomy as monotherapy or in combination with scar resection resulted in recovery after one treatment in 16 out of 17 patients.ConclusionsInternal optical urethrotomy as monotherapy or in combination with scar resection was effective in nearly all patients with bladder neck stenosis.

Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre.

ABSTRACTPurpose:The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI).Materials and methods:We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL).Results:From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open prostatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% adjuvant radiotherapy; 57.7% had already undergone surgical treatment for urinary incontinence. The average24 hours pad test was 411.6 g (180 – 1100). The mean follow-up was 20.1 months (8.1 – 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ - UI SF scores (p < 0.01).In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants.Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11).Conclusions:The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

Ejaculation Preserving Technique in TURP Is it safe?

Background: The treatment of bladder outlet obstruction in patients diagnosed with benign prostatic hyperplasia using the transurethral resection of the prostate procedure often presents with retrograde ejaculation as a complication due to bladder neck stenosis. Objective:To determine the safety and ease of use of the ejaculation preservation technique of the transurethral resection of the prostate procedure. Patients and Methods: The study was done in Samarra city in Iraq, included 30 patients between the ages of 50 and 62 years. The resection of the prostate was done a centimeter above the verumontanum in order to preserve the paraculcular tissue. The patients were assessed for the degree of ejaculate using the Ejaculation Projection Score. The patients were also evaluated for erectile function using the International Index of Erectile Function and for urinary retention using the International Prostate Symptom Score. The assessments were done preoperative, 4 months and 36 months after the ejaculation-preserving transurethral resection of the prostate procedure. Results: The maximum flow rate increased from 5.4ml/s to 21±5.2ml/s (n=29, p-value<0.001). IPSS improve from 24 to 5±2.5 (n=29, p-value<0.001). The quality of life score improved from 5.7 to 1.4±1.0 (n=29, p-value<0.001). The residual urine volume reduced from 150ml to 23± 14 (n=29, p-value<0.001). The erectile function reduced from 4 to 3.7 while the EPS reduced from 3.5±0.5 to 3.3+-0.5 (p-value=0.57). 96.7% of the patients ejaculated postoperatively. Statistical analysis was done with SPSS version 15 for windows, P value and T test for significance of results being P value < 0.05. Conclusion: There is evidence to show that the ejaculation preserving technique of the transurethral resection of the prostate is safe and secure to use. It protects anterograde ejaculation while reducing urine retention.

Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases

ObjectivesTo report our experience with the emerging technique of thulium laser enucleation of the prostate (ThuLEP) for the treatment for prostate hyperplasia. Patients and methodsOur inclusion criteria were an International Prostate Symptom Score (IPSS) of >15 and a quality-of-life (QoL) score of >3 in patients with confirmed bladder outflow obstruction, no longer responsive to medical therapy, with a significant post-void residual urine volume (PVR; >100 mL), with or without recurrent urinary tract infection and/or acute urinary retention. Patients with neurogenic bladder, urethral strictures, bladder stones, and previously failed transurethral prostate surgery were excluded. ResultsIn all, 139 men were included in the study. The mean age was 67.8 years. The IPSS and QoL score improved by 17.6 and 2.6, respectively. The flow rate increased from a mean of 9.6 mL to 31.2 mL and the PVR decreased from a mean of 131 mL to 30 mL. On univariate and multivariate analyses, operating time was a predictive factor for haemoglobin drop during the operation. Heparin prophylaxis was the only risk factor identified for postoperative bleeding. Two patients (0.01%) required blood transfusion. One patient (0.007%) required re-intervention for bleeding control, and two patients developed urethral and bladder neck strictures (0.01%). ConclusionThuLEP is safe and reproducible. Whilst it significantly reduces intraoperative bleeding as compared to transurethral resection of the prostate, operating time and perioperative heparin prophylaxis may still lead to a Hb drop and constitute a risk factor for postoperative bleeding. Therefore, a potential risk of deep vein thrombosis requiring heparin prophylaxis should be carefully considered and balanced with the expected clinical benefit of the operation.

MP06-07 LONG-TERM OUTCOME OF HEMATURIA - PROSPECTIVE LARGE COHORT

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2018MP06-07 LONG-TERM OUTCOME OF HEMATURIA - PROSPECTIVE LARGE COHORT S Mishriki S MishrikiS Mishriki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hematuria accounts for a significant proportion of urology outpatient referrals. This prospective large cohort study with long-term follow-up aims to evaluate the outcomes for non-visible hematuria (NVH) versus visible hematuria (VH). The guidelines for hematuria are unclear. METHODS Between 1999 and 2007, 2778 patients presenting with either NVH (974) or VH (1804) were investigated with upper tract imaging using ultrasound (U/S) and/or intravenous urography (IVU), computerised tomography (CTU), urine cytology and cystoscopy. Patient details, investigation results and clinical diagnoses were entered into a Microsoft Access hematuria database. The presenting features and range of pathologies detected were fully analysed. In 2017 a final analysis was performed using electronic patient records. RESULTS The findings for both NVH and VH included urinary tract infection, renal cysts, large bleeding prostates, renal tumours, bladder tumours, prostate cancer, urethral stricture / bladder neck stenosis and bladder calculi. In 63% of patients, no pathology was identified. The findings for NVH and VH were significantly different. In NVH patients 13.3% had benign pathology, 4.8 % had malignant pathology and 81% had no pathology. In the VH patients 31.9% had benign pathology, 21.9 % had malignant pathology and 50.3% had no pathology. None of the recurrent NVH that were re-investigated had a malignant diagnosis. However, more than 50% of recurrent VH had no pathology. CONCLUSIONS For the NVH group, the majority cleared by initial investigations remained asymptomatic. For the VH group, recurrence of VH indicated pathology in more than 50%. Therefore, vigilance and repeat investigation may be required in VH patients. As the findings in the NVH and VH groups were significantly different, investigations should be tailored to patient age and the type of hematuria. The Hematuria guidelines need to be refined. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e54 Advertisement Copyright & Permissions© 2018MetricsAuthor Information S Mishriki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes.

Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). However, photoselective vaporization of the prostate (PVP) has gained widespread global acceptance in national guidelines as a safe and effective alternative option. Nevertheless, further evidence is required to assess the durability of Greenlight PVP. Herein, we report our five years of PVP experience with the Greenlight 180W XPS laser system. A retrospective analysis was conducted on a prospectively gathered database of 370 consecutively included patients who underwent PVP using Greenlight XPS-180 W laser system (Boston Scientific, Boston, MA, U.S.) performed by a single experienced laser surgeon between 2011 and 2016. Preoperative characteristics, intervention parameters, postoperative functional, uroflowmetry outcomes, and complications were collected. Outcomes are reported over a period of five years. Mean age was 68 years, with a mean prostate volume of 78.8 cc (95% confidence interval [CI] 70.9-78.7]). The mean followup was 59.4 months (55.4-63.5). Mean energy, operative time, and energy/cc were 270.2 kJ (255.2-285.2), 62.7 minutes (59.6-65.7), and 3.7 kJ/cc (3.6-3.9), respectively. Compared to preoperative values, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR) parameters were significantly improved and sustained over the five postoperative years. Of note, only 66 patients (out of 370) had a complete five-year followup. Prostate-specific antigen (PSA) reached nadir at one year, with a drop of 67% from the mean preoperative value of 6.2 ng/mL. Mean IPSS nadir was reached at three years, with a drop of 80.4% (-21.1 points). Similarly, mean quality of life (QoL) score dropped by 82.8% after three years (preoperative mean of 4.7). With respect to mean Qmax, there was an increase by 72.7% (+14.7 mL/s) at one year, reaching the value of 19.9 mL/s. Moreover, mean PVR was 32.8 mL at four years compared to 345 mL preoperatively. At five years followup, PSA, IPSS, QoL, and PVR dropped by 59.7% (3.7 ng/mL), 75.2% (19.7 points), 78.72% (3.7 points), and 84.4% (291.3 mL), respectively. Qmax increased by 12.9 mL/s. Clavien complication rates were low, with bladder neck stenosis observed in seven (1.6%) men. During the five-year followup, only four patients (1%) required BPH surgical re-intervention. This is the first long-term reporting of Greenlight XPS-180W laser system. In experienced hands, the observed outcomes appear to demonstrate that Greenlight XPS-180 W laser system is safe, efficacious, and durable for the treatment of bladder outlet obstruction (BOO) secondary to BPH.

Optimisation of sonourethrography: the clamp method.

To describe the clamp method for performing retrograde sonourethrography (RSUG) and contrast-enhanced voiding sonourethrography (CE-VSUG) via the transperineal approach in male adults. Prospective study of 113 males (14-86 years) with urethral strictures confirmed by urethrography who received sonourethrography via the clamp method between 2011 and 2015. The characteristic parameters of the quantitative variables were calculated and a comparative analysis of the qualitative variables was conducted using the McNemar test. RSUG was performed successfully in all the cases (n = 113) and detected 49 cases with anterior urethral strictures; the strictures in the proximal bulbar cone in five of them (10.2%) were not visualised on retrograde urethrography (RUG) (p < 0.05). CE-VSUG was performed successfully in 97 cases and observed posterior urethral strictures in 82; the bladder neck strictures in 6 of them (7.3%) were not observed on voiding cystourethrography (VCUG) (p < 0.05). Retrograde bladder filling was achieved in approximately 6 min. The clamp method enables RSUG and CE-VSUG to be performed simply, effectively and painlessly by a single operator. It also allows the evaluation of cases with urethromeatal alterations (stricture, hypospadias and meatotomy). • The clamp method enables RSUG to be performed simply and painlessly. • The clamp method requires only one operator and allows assessing urethromeatal alterations. • RSUG shows greater capacity for detecting anterior urethral strictures than RUG. • The clamp method achieves retrograde bladder filling in approximately 6 min. • CE-VSUG shows greater capacity for detecting strictures than VCUG.

The T-plasty as therapy for recurrent bladder neck stenosis: success rate, functional outcome, and patient satisfaction.

To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the bladder neck in case of recurrent bladder neck stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients' charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62-73)years. Most patients had BNS due to TUR-P [n=25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18-64)months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q max, mean Q max post-OP improved significantly [pre-OP 6.79 (SD±4.76) ml/s vs post-OP was 24.42 (SD±12.61)ml/s; (t(5)=4.12, p=0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD±105.41)ml vs post-OP 14.5 (SD±22.42)ml; (t(9)=-3.86, p=0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD±2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

Differences in Recurrence Rate and De Novo Incontinence after Endoscopic Treatment of Vesicourethral Stenosis and Bladder Neck Stenosis.

The objective of this study was to compare the recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral stenosis (VUS) after radical prostatectomy (RP) and for bladder neck stenosis (BNS) after transurethral resection of the prostate (TURP). Retrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups. A total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44-86), mean follow-up 27.1 months (1-98). Mean time to recurrence after initial therapy was 23.9 months (1-156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1-159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p = 0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; p = 0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p = 0.031). The mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p = 0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p = 0.091), whereas the rate of de novo incontinence (13.8 for VUS vs. 0% for BNS; p = 0.005) stayed significantly higher in patients treated for VUS. Most patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to de novo incontinence. Patients must be counseled regarding the increased risk of de novo incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer.

The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

Efficacy of solifenacin in the prevention of short-term complications after laparoscopic radical prostatectomy.

Objective To evaluate the efficacy of solifenacin in the prevention of short-term complications after laparoscopic radical prostatectomy (LRP).MethodsThis randomized placebo-controlled study enrolled patients with histologically proven prostate cancer who underwent LRP. The patients were randomized to receive either solifenacin (5 mg once daily; study group) or placebo (control group) for the 15-day period beginning on the first day after surgery. The mean duration of detrusor overactivity (DO), the frequency of DO, the duration of macroscopic haematuria, and the days before catheter removal were recorded. The International Continence Society Short Form Male questionnaire, bladder neck stenosis episodes, and maximum urinary flow rate were evaluated at 1 month after surgery. The side-effects after using solifenacin were also recorded.ResultsA total of 120 patients were randomly assigned to the study group (n = 62) or the control group (n = 58). There were significantly lower rates of DO episodes during the daytime and night-time, haematuria and transient incontinence in the study group compared with the control group.ConclusionSolifenacin was a well-tolerated and effective treatment for the prevention of complications after LRP, with the main advantage compared with placebo being the decreased frequency of DO episodes during the daytime and night-time.

Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer.

To assess short- to medium-term cancer control rates and side effects of focal salvage high- intensity focused ultrasound (HIFU). A retrospective registry analysis identified 150 men who underwent focal salvage HIFU (FS-HIFU) (Sonablate 500) between November 2006 and August 2015. Metastatic disease was excluded by nodal assessment on the pelvic MRI, a radioisotope bone scan and positron-emission tomography (PET) imaging (choline-18F-fluorodeoxyglucose PET or choline PET-CT). In our current clinical practice, metastatic disease must be excluded by both choline PET and bone scan. Localization of cancer was carried out using multiparametric MRI of the prostate (T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging) with systematic or template prostate mapping biopsies. The primary outcome was a composite failure incorporating biochemical failure (BCF) and/or positive localized or distant imaging results and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer-specific death. The secondary outcome was BCF using the Phoenix-ASTRO definition (prostate-specific antigen [PSA] nadir + 2ng/mL). We used Kaplan-Meier analysis and Cox proportional hazards regression to quantify the effect of the determinants on the endpoints. The mean (standard deviation [sd]) patient age at focal salvage HIFU was 69.8 (6.1) years and the median (interquartile range [IQR]) PSA pre-focal salvage HIFU was 5.5 (3.6-7.9) ng/mL. The median (IQR) follow-up was 35 (22-52) months. Patients were classified as having low- 2.7% (4/150), intermediate- 39.3% (59/150) and high-risk disease 41.3% (62/150) according to D'Amico classification, prior to focal salvage HIFU. Composite failure occurred in 61% of patients (91/150) and BCF occurred in 51.3% (77/150). The Kaplan-Meier composite endpoint-free survival (CEFS) rate at 3years was 40% (95% confidence interval [CI] 31-50) for the entire group. Kaplan-Meier estimates of CEFS were 100%, 49% and 24% at 3years in the low-, intermediate- and high-risk groups pre-salvage HIFU, respectively. The Kaplan-Meier biochemical disease-free survival (BDFS) rate at 3years was 48% (95% CI 39-59) for the entire group. Kaplan-Meier estimates of BDFS were 100%, 61% and 32% at 3years in the low-, intermediate- and high-risk groups pre-salvage HIFU, respectively. Complications included urinary tract infection (11.3%; 17/150), bladder neck stricture (8%; 12/150), recto-urethral fistula after one HIFU procedure (2%; 3/150) and osteitis pubis (0.7%; 1/150). Focal salvage HIFU conferred a relatively low complication and side effect rate. CEFS and biochemical control in the short to medium term were reasonable, especially in this relatively high-risk cohort, but still low compared with current whole-gland salvage therapies. Focal salvage therapy may offer disease control in men at high risk whilst minimizing additional treatment morbidities.

MP02-02 PURE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE: 5-YEAR FOLLOW-UP FROM A PROSPECTIVE 3D ULTRASOUND VOLUMETRY STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2017MP02-02 PURE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE: 5-YEAR FOLLOW-UP FROM A PROSPECTIVE 3D ULTRASOUND VOLUMETRY STUDY Benedikt Kranzbühler, Oliver Gross, Christian D. Fankhauser, Marian S. Wettstein, Nico C. Grossmann, Etienne X. Keller, Daniel Eberli, Tullio Sulser, Cédric Poyet, and Thomas Hermanns Benedikt KranzbühlerBenedikt Kranzbühler More articles by this author , Oliver GrossOliver Gross More articles by this author , Christian D. FankhauserChristian D. Fankhauser More articles by this author , Marian S. WettsteinMarian S. Wettstein More articles by this author , Nico C. GrossmannNico C. Grossmann More articles by this author , Etienne X. KellerEtienne X. Keller More articles by this author , Daniel EberliDaniel Eberli More articles by this author , Tullio SulserTullio Sulser More articles by this author , Cédric PoyetCédric Poyet More articles by this author , and Thomas HermannsThomas Hermanns More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.098AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pure bipolar plasma vaporization (BPV) has been established as low-morbidity alternative to conventional transurethral resection of the prostate (TURP). Low intra- and postoperative morbidity as well as excellent functional short-term results have been reported. However, long-term outcome is still lacking. The extent of prostate tissue removal, which impacts the durability of postoperative functional improvements, is also unknown after BPV. The aim of the present study was to investigate the long-term functional outcome and associated prostate volume changes following pure BPV of the prostate. METHODS A consecutive series of 75 patients treated by pure BPV in a tertiary care academic center was prospectively investigated. Prostate volume was assessed using planimetric volumetry following transrectal 3D-ultrasound of the prostate. Prostate volume and clinical parameters were recorded preoperatively and regularly after BPV (after catheter removal, 6W, 6M, 1, 3 and 5Y). RESULTS Median (interquartile range; IQR) preoperative prostate volume was 41 ml (26.8ml), IPSS 16 (10), QoL 4 (2), Qmax 10.1ml/s (8ml/s), PVR 91ml (140ml) and PSA 2.57ng/ml (3.5ng/ml). A significant relative prostate volume reduction (RVR) of 33.3% (IQR: 22.3%; p<0.001) was already detectable at the time of catheter removal. Relative volume reduction increased significantly up to 12M (6W: 45.9% (17.4%; p<0.001), 6M: 50.5% (16.1%; p<0.001) and 12M 52.2% (17.4%; p=0.014). After 12M the RVR remained stable with 50.6% (14.3%; p=0.58) after 3Y and 52.6% (14.1%; p=0.59) after 5Y. Postoperatively, all investigated clinical parameters improved significantly and remained stable during the 5Y follow-up [5Y results (IQR): IPSS: 3 (8), QoL: 1 (1), Qmax: 16.3ml/s (13.7ml/s), PVR 20ml (46.5ml)]. Median PSA reduction after 5Y was 55% (36.2%). During the observation period 9 urethral strictures (12%) were detected of which 7 were de novo strictures. Bladder neck incisions for postoperative bladder neck stenosis were performed in 6 patients (8%). Median prostate volume in these patients was 30.6ml (18.2ml). Re-resections for re-grown adenoma were not necessary. CONCLUSIONS Low intra- and postoperative morbidity in combination with excellent functional outcome and durable prostate volume reduction confirm the role of contemporary BPV as a minimally invasive alternative to conventional TURP. However, postoperative bladder neck stenoses appeared rather frequent after BPV and might be a procedure-specific drawback. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e10 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Benedikt Kranzbühler More articles by this author Oliver Gross More articles by this author Christian D. Fankhauser More articles by this author Marian S. Wettstein More articles by this author Nico C. Grossmann More articles by this author Etienne X. Keller More articles by this author Daniel Eberli More articles by this author Tullio Sulser More articles by this author Cédric Poyet More articles by this author Thomas Hermanns More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical study and management of bladder outlet obstruction

Background: The incidence of bladder outlet obstruction is different and varied in both age and gender. Hence this study was conducted to assess the incidence, etiology and management of bladder outlet obstruction in patients above 18 years of age in both sexes.Methods: This was a tertiary care hospital based longitudinal study. A total of 100 cases were recruited during the period between 01st June 2014 to 31st May 2016 with objective evidence of bladder outlet obstruction. The subject's demographic data, incidence, etiological factors and clinical presentations of bladder outlet obstruction were recorded on data sheet and analyzed.Results: Male preponderance was observed in the study. Maximum incidence of bladder outlet obstruction was observed in the age group of 60-69 years. The most common cause for bladder outlet obstruction in males was benign prostate hyperplasia (BPH), where as in females the major etiological factor was bladder neck stenosis. Out of 94 cases causing bladder outlet obstruction in males, 37 underwent TURP, 11 cases were treated with alpha blockers like Tamsulosin (medical management), 9 underwent cystolithotripsy, 8 underwent b/l orchidectomy, 7 underwent radical cystectomy and ileal conduit, 7 underwent VIU, 7 underwent urethroplasty, 5 underwent open prostatectomy, 3 underwent cystolithotomy whereas in female’s bladder neck stenosis treated by bladder neck incision.Conclusions: Men were the most affected with BPH, being the leading cause. Among women, bladder neck stenosis was the main cause. Initial and definitive management were varied between causes, gender and age.