Recurrent Bladder Outlet Obstruction Research Articles

Devastated bladder outlet-suprapubic catheter vs. reconstruction

The combination of asevere urethral sphincter defect with simultaneous development of recurrent bladder outlet obstruction characterizes a"devastated bladder outlet", which often is not surgically reconstructable. Clinically, quality of life is considerably compromised in affected patients with awide variance of symptoms, mostly complete incontinence, but also urinary retention. This condition is usually preceded by multiple endoscopic interventions or even open surgical procedures, occasionally also in combination with radiotherapy of the pelvic region as part of multimodal oncological therapy. Treatment of these cases is complex and limited to few promising procedures. Apotential therapy should primarily include the decision about the possibility of preserving the urinary bladder. In individual cases, this can result in simple therapy options while at the same time maintaining an acceptable quality of life for those affected. If there is no possibility of arefunctionalization of the original bladder, supravesical urinary diversion is indicated as alast-resort therapy. This paper provides a review as well as the limits and possibilities of conservative and surgical treatment options for adevastated bladder outlet.

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

The RevoLix(™) 2 μm Continuous Wave Laser Vaporesection for the Treatment of Benign Prostatic Hyperplasia: Five-Year Follow-Up.

The purpose of this study was to evaluate the long-term efficacy and safety of laser vaporesection using the RevoLix(™) 70 W 2 μm continuous wave (CW) laser in the treatment of benign prostatic hyperplasia (BPH). From January 2008 to December 2008, 162 patients with BPH underwent vaporesection using 2 μm CW laser. The International Prostate Symptom Score (IPSS), quality of life (QoL), urinary flow rate (Qmax), post-voiding residual urine volume (PVR), and postoperative complications were observed at baseline and were followed at 3-, 6-, and 12-month intervals (range: 3-60 months). A total of 146 patients completed the 5-year follow-up. At 60 months postoperatively, the mean Qmax increased from 7.5 to 21.2 mL/sec, the mean PVR decreased from 94.3 to 9.4 mL, the mean IPSS score decreased from 20.4 to 6.6, and the mean QoL score decreased from 4.7 to 1.9. Complications included urinary tract infection (3.4%), urethral stricture rate (2.7%), and recurrent bladder outlet obstruction rate (2.1%). Overall, the reoperation rate was 3.4%, and no transurethral resection (TUR) syndrome or blood transfusion was reported. The 2 μm CW laser is a safe and effective option for the treatment of BPH. At the 5-year follow-up, the long-term clinical efficacy and safety are excellent, with low incidence of complications.

The Patient Burden of Bladder Outlet Obstruction after Prostate Cancer Treatment

Bladder outlet obstruction after prostate cancer therapy imposes a significant burden on health and quality of life in men. Our objective was to describe the burden of bladder outlet obstruction after prostate cancer therapy by detailing the type of procedures performed and how often those procedures were repeated in men with recurrent bladder outlet obstruction. Using SEER (Surveillance, Epidemiology and End Results)-Medicare linked data from 1992 to 2007 with followup through 2009 weidentified 12,676 men who underwent at least 1 bladder outlet obstruction procedure after prostate cancer therapy, including external beam radiotherapy in 3,994, brachytherapy in 1,485, brachytherapy plus external beam radiotherapy in 1,847, radical prostatectomy in 4,736, radical prostatectomy plus external beam radiotherapy in 369 and cryotherapy in 245. Histogram, incidence rates and Cox proportional hazards models with repeat events analysis were done to describe the burden of repeat bladder outlet obstruction treatments stratified by prostate cancer therapy type. We describe the type of bladder outletobstruction surgery grouped by level of invasiveness. At a median followup of 8.8 years 44.6% of men underwent 2 or more bladder outlet obstruction procedures. Compared to men who underwent radical prostatectomy those treated with brachytherapy and brachytherapy plus external beam radiotherapy were at increased adjusted risk forrepeat bladder outlet obstruction treatment (HR 1.2 and 1.32, respectively, each p <0.05). After stricture incision the men treated with radical prostatectomy or radical prostatectomy plus external beam radiotherapy were most likely to undergo dilation at a rate of 34.7% to 35.0%. Stricture resection/ablation was more common after brachytherapy, external beam radiotherapy or brachytherapy plus external beam radiotherapy at a rate of 28.9% to 41.2%. Almost half of the men with bladder outlet obstruction after prostate cancer therapy undergo more than 1 procedure. Furthermore men with bladder outlet obstruction after radiotherapy undergo more invasive endoscopic therapies and are at higher risk for multiple treatments than men with bladder outlet obstruction after radical prostatectomy.

Five-Year Follow-Up Study of Transurethral Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia.

To explore the long-term clinical efficacy and safety of transurethral plasmakinetic resection of the prostate (PKRP) for benign prostatic hyperplasia (BPH). A total of 550 patients with BPH who had undergone PKRP from October 2006 to September 2009 were enrolled in this study. All patients were evaluated at baseline and follow-up (3, 12, 24, 36, 48, 60 months postoperatively) by peak flow rate (Qmax), postvoid residual (PVR), quality of life (QoL), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Operative details and postoperative complications regarded as safety outcomes were documented. A total of 467 patients completed the 5-year follow-up. The mean duration of surgery was 36.43 minutes, mean catheterization time was 48.81 hours, mean hospital stay was 4.21 days. At 60 months postoperatively, the mean Qmax increased from 6.94 mL/s at baseline to 19.28 mL/s, the mean PVR decreased from 126.33 mL to 10.45 mL, the mean IPSS score decreased from 15.79 to 7.51, the mean QoL score decreased from 4.36 to 1.91, and the mean OABSS score decreased from 6.39 to 3.65 (P < 0.001), respectively. In perioperative complications, the blood transfusion rate was 2.7%, urinary tract infection rate was 3.6%; no transurethral resection syndrome (TUR syndrome) occurred. In late complications, urethral stricture rate was 5.4%, recurrent bladder outlet obstruction rate was 2.1%, and the reoperation rate was 4.5%. PKRP is based on conventional monopolar transurethral resection of the prostate (TURP) and uses a bipolar plasmakinetic system. Our results indicate that the long-term clinical efficacy and safety of PKRP for BPH are remarkable. In particular, the incidence of urethral stricture, recurrent bladder outlet obstruction, and reoperation is low. We suggest that PKRP is a reliable minimally invasive technique that may be the preferred procedure for the treatment of patients with BPH.

V332 HOLMIUM LASER INCISION OF BLADDER NECK FOR POST-PROSTATECTOMY BLADDER NECK STENOSIS

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2010V332 HOLMIUM LASER INCISION OF BLADDER NECK FOR POST-PROSTATECTOMY BLADDER NECK STENOSIS Hemendra Shah Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder neck stenosis is an inherent long term complication of prostatectomy for bladder outlet obstruction. We present our experience with Holmium laser incision of post-prostatectomy bladder neck stenosis. To the best of our knowledge, there is no information on the outcome of this procedure in the literature. METHODS Retrospective review of 11 patients with post-prostatectomy bladder neck stenosis who underwent bladder neck incision with holmium laser at our institute from May 2003 to June 2008 was performed. All patients had an ascending urethrogram & cystoscopy to diagnose bladder neck stenosis. The procedure was performed using 550 μ laser fiber at 100 W holmium laser energy. Initially incision was taken at 5 and 7o clock position and deepened till all fibrous tissue is cut. Later on the fibrous tissue is resected using the holmium laser. An additional 12 o clock &/or 6o clock incision is take to completely release all the fibrous tissue. The remaining residual fibrous tissue is vaporized. All patients had a per urethral catheter for 1 day. Patients demographic and perioperative data was analyzed to know the safety and efficacy of the procedure. Follow-up data was obtained to know early outcome of surgery. Digital video clips from previously recorded Holmium laser incision of post-prostatectomy bladder neck stenosis were edited into a video describing the steps of procedures. RESULTS The primary procedure for prostatectomy was open prostatectomy (1); TURP (7) and HoLEP (3). All patients presented with recurrent bladder outlet obstruction after initial prostatectomy. The mean interval between prior prostatectomy and presentation was 1.9 years (3 months – 9 years). The mean pre-prostatectomy prostate size (available in 8 patients) was 34.8 gm (11- 72 gm). The mean preoperative AUA symptom score, maximum uroflow rate and post-void residual urine were 24, 7.2 ml/sec and 112 ml respectively. There were no major intraoperative or post-operative complications. At mean follow-up of 21 months, no patients had recurrent bladder neck stenosis. The mean postoperative AUA symptom score, maximum uroflow rate and post-void residual urine during last available follow-up were 7, 19.8 ml/sec and 33 ml respectively. CONCLUSIONS Holmium laser bladder neck incision is associated with favorable early postoperative outcome. Mumbai, India© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e132 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hemendra Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Recurrent bladder outlet obstruction and urodynamics

Recurrent bladder outlet obstruction and urodynamics

Necrotizing Granulomatous Vasculitis With Eosinophilic Infiltrates Limited to the Prostate. Case Report and Review of the Literature

A 67-year-old white man presented with recurrent bladder outlet obstruction due to allergic granulomatous prostatitis, with no evidence of asthma, allergies, or systemic vasculitis. He is currently doing well on a slowly tapering course of prednisone therapy and has had no recurrence of bladder outlet obstruction. This entity, although rare, must be promptly recognized in order that the proper studies can be performed to search for systemic vasculitis, and the appropriate therapy can be initiated to avoid further bladder outlet obstruction and loss of renal function.

Necrotizing granulomatous vasculitis with eosinophilic infiltrates limited to the prostate: Case report and review of the literature

A 67-year-old white man presented with recurrent bladder outlet obstruction due to allergic granulomatous prostatitis, with no evidence of asthma, allergies, or systemic vasculitis. He is currently doing well on a slowly tapering course of prednisone therapy and has had no recurrence of bladder outlet obstruction. This entity, although rare, must be promptly recognized in order that the proper studies can be performed to search for systemic vasculitis, and the appropriate therapy can be initiated to avoid further bladder outlet obstruction and loss of renal function.