Transurethral Incision Of Bladder Neck Research Articles

An Alternative Approach for Treating Female Underactive Bladders with Chronic Urine Retention: A Pilot Study on Combined Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck.

Background: Treating an underactive bladder (UAB) is challenging. Previously, we introduced a more precise method of transvaginal ultrasound-guided botulinum toxin A (BoNT-A) injection into the external urethral sphincter as a treatment option for patients with UABs. Although many patients experience good results, those with an UAB and excessive residual urine still require catheterization. Therefore, we developed a new method that combines transvaginal ultrasound-guided BoNT-A injection with a transurethral bladder neck incision. Methods: A prospective study was conducted on 16 patients who experienced symptoms of UAB and chronic urine retention. The treatment consisted of a combination of transvaginal ultrasound-guided BoNT-A injection and a transurethral incision of the bladder neck (TUI-BN). The primary objective was to assess the efficacy of this combined treatment in improving symptoms in women with UABs. Results: Our study demonstrated significant improvements after treatment, including increased voiding volume, decreased post-void residual (PVR) urine, and improved voiding efficiency. The frequency of clean intermittent catheterization (CIC) decreased at 1 and 3 months post-surgery, along with improvements in the AUA symptoms score and the Patient Perception of Bladder Condition (PPBC) score. Conclusions: Our study showed significant improvements in the surgical treatment of UABs using a combination of transvaginal ultrasound-guided BoNT-A and TUI-BN.

101 - A Novel Treatment for Female Underactive Bladder with Chronic Urine Retention: Combining Transvaginal Ultrasound- Guided Botulinum Toxin A Injection and Transurethral Bladder Neck Incision

101 - A Novel Treatment for Female Underactive Bladder with Chronic Urine Retention: Combining Transvaginal Ultrasound- Guided Botulinum Toxin A Injection and Transurethral Bladder Neck Incision

Efficacy of single and repeated transurethral bladder neck incisions for female voiding dysfunction.

This study aimed to assess the efficacy of single and repeat transurethral bladder neck incision (TUI-BN) for female voiding dysfunction caused by bladder outlet obstruction (BNO). Further, the predictive factors associated with better treatment outcomes were identified. Women with voiding difficulty due to BNO who underwent TUI-BN were included in this research. All patients underwent videourodynamics study at baseline and after TUI-BN. Successful outcome was defined as a voiding efficiency of ≥ 66.7% and a global response assessment score of ≥ 2 after treatment. Repeat TUI-BN was considered for patients with insufficient improvement. The outcomes of repeat surgery, surgical complications, and predictive factors of successful outcomes were evaluated. In total 158 cases, the success rates were 61.4% and 45.2% after the first and second TUI-BN, respectively, with an overall cumulative rate of 70.3%. The success rates were comparable between patients with detrusor underactivity (DU) and those without (54.9% vs. 68.4%). The absence of a previous history of suburethral sling and a high baseline corrected maximum flow rate were a significant predictor of favorable outcomes. The cumulative rate of regaining self-voiding function was 95.1%. The incidence rates of vesico-vaginal fistula and de novo stress urinary incontinence requiring surgery were 1.2% and 2.5%, respectively. Regardless of the presence of DU, TUI-BN is effective against female voiding dysfunction caused by BNO. Repeat procedures are beneficial and can improve self-voiding function. A high corrected maximum flow rate and the absence of a previous history of suburethral sling can contribute to greater success rates.

MP51-04 REZŪM WATER VAPOUR THERAPY (REZŪM): IS IT SAFE TO CONTINUE ANTIPLATELET OR ANTICOAGULATION MEDICATION?

You have accessJournal of UrologyCME1 Apr 2023MP51-04 REZŪM WATER VAPOUR THERAPY (REZŪM): IS IT SAFE TO CONTINUE ANTIPLATELET OR ANTICOAGULATION MEDICATION? Samuel Lee, Benjamin Lim, Thomas Chan, Shu Hui Neo, Alvin Low, Joshua Tung, Palaniappan Sundaram, Christopher Cheng, Lui Shiong Lee, and Yong Wei Lim Samuel LeeSamuel Lee More articles by this author , Benjamin LimBenjamin Lim More articles by this author , Thomas ChanThomas Chan More articles by this author , Shu Hui NeoShu Hui Neo More articles by this author , Alvin LowAlvin Low More articles by this author , Joshua TungJoshua Tung More articles by this author , Palaniappan SundaramPalaniappan Sundaram More articles by this author , Christopher ChengChristopher Cheng More articles by this author , Lui Shiong LeeLui Shiong Lee More articles by this author , and Yong Wei LimYong Wei Lim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm water vapour therapy is a minimally invasive surgical technique for treatment of benign prostatic hyperplasia (BPH). Antiplatelets or anticoagulation medications (APAC) are usually suspended prior to Rezūm to reduce the risk of bleeding. Continuation of APAC reduces the risk of cardiovascular events for patients with advanced age and multiple comorbidities. This study aims to report the outcomes of Rezūm in patients who are continued on antiplatelet or anticoagulation medication. METHODS: All patients on antiplatelet or anticoagulation medication who had undergone Rezūm from November 2021 to August 2022 at a single centre in Singapore were followed up for 3 months. APAC were continued perioperatively. Outcomes were measured at 1 month, 2 month and 3 months postoperatively. RESULTS: N=15 men underwent Rezum while on APAC. 13 patients (87%) were on single antiplatelet therapy, 1 patient (7%) on novel anticoagulation therapy (NOAC): apixaban, and 1 patient (7%) on both NOAC and antiplatelet therapy: apixaban and clopidogrel. There was a sustained improvement in Qmax. 13 out of 15 patients (87%) had a successful removal of catheter. No complications of Clavien-Dindo classification greater than two at 30 days were observed. 2 patients (13%) required a manual bladder washout postoperatively. 1 patient (7%) was readmitted for a urinary tract infection and orchitis. 1 patient (7%) had a bladder neck contracture, who required an elective transurethral bladder neck incision after 2 months. CONCLUSIONS: This pilot study suggests that Rezum is a safe and effective option for patients who have bothersome lower urinary tract symptoms, and cannot stop anticoagulation or antiplatelet medication. Source of Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e693 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Lee More articles by this author Benjamin Lim More articles by this author Thomas Chan More articles by this author Shu Hui Neo More articles by this author Alvin Low More articles by this author Joshua Tung More articles by this author Palaniappan Sundaram More articles by this author Christopher Cheng More articles by this author Lui Shiong Lee More articles by this author Yong Wei Lim More articles by this author Expand All Advertisement PDF downloadLoading ...

The Long-term Effects of Transurethral Bladder Neck Incision in the Treatment of Female Bladder Neck Obstruction.

To investigate the long-term effects of transurethral bladder neck incision (TUBNI) for female primary bladder neck obstruction (PBNO). We retrospectively reviewed seventy women diagnosed with bladder neck obstruction by video-urodynamic study (VUDS). TUBNI was performed for each patient, with incisions made at 2 different sites on the bladder neck. Postoperatively, patients were assessed by international prostate symptom score (IPSS), quality of life (QOL) and uroflowmetry. Follow-up data were available for 4-108 months (median 42 months) postoperatively. During follow-up, the IPSS, QOL, time to maximum uroflow rate, postvoid residual urine volume decreased significantly after TUBNI compared with preoperative [13.0 (10.0, 15.0) versus 3.0 (3.0, 8.0), P ＜ .001], [5.0 (5.0, 5.0) versus 2.0 (1.0, 3.0), P ＜ .001], [9.0 (5.0, 37.0) versus 6.1 (4.2, 8.7), P ＜ .001], [77.5 (23.5, 165.8) versus 0.0 (0.0, 30.0), P ＜ .001]. The maximum uroflow rate, average uroflow rate and the voided volume increased significantly compared with preoperative [7.0 (4.0, 10.3) versus 19.8 (12.8, 25.2), P ＜ .001], [3.0 (2.0, 5.0) versus 8.0 (4.9, 10.7), P ＜ .001] and [156.5 (85.0, 211.3) versus 261.3 (166.2, 345.6), P ＜ .001]. Several complications were identified after surgery, including bladder neck reobstruction, urethral stricture, and stress urinary incontinence, the corresponding number was 5 (7.1%), 7(10%) and 7(10%). Successful operation was achieved in 60/70 (85.7 %) patients. PBNO is a very rare yet easily treatable condition. VUDS is the primary diagnostic tool for the diagnosis of bladder neck obstruction in women, while TUBNI can effectively relieve obstruction symptoms and improve the quality of life for patients.

Rezum to the rescue: Early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement.

We aim to report the short-term outcomes of patients undergoing Rezum as a re-treatment intervention for recurrent lower urinary tract symptoms after prior surgical treatment for benign prostate enlargement. Data from two institutions for baseline International Prostatic Symptom Score with Quality of life item, prostate size, and maximum flow-rate was acquired. Patients were assessed 3-month post-treatment. Outcomes were compared with unpaired t-tests and Fisher's exact tests. Nineteen patients were included. Prior surgical interventions included transurethral resection of the prostate (31.6%, n=6), Urolift (26.3%, n=5), transurethral bladder neck incision (15.8%, n=3), prostate artery embolization (10.5%, n=2), transurethral needle ablation, greenlight photovaporization of prostate and Rezum (5.3%, n=1 each). Median age was 69.0 years (IQR 14; range 59-87 years) with a median prostate volume of 65.0ml (IQR 63; range 22-160 ml). The median time to Rezum treatment was 48 months (IQR 78; range 9-240 months). 63.1% (n=12) were re-started on benign prostatic enlargement medication and 36.8% (n=7) had recurrent bothersome symptoms before re-treatment with Rezum. At 3-month follow up, median International Prostatic Symptom Score decreased from 23 to 9 (p < 0.001) and Quality of life from 4 to 2 (p < 0.001). Median maximum flow-rate improved after treatment from 8.6 to 14.8ml/s (p < 0.001). None of the patients were required to restart medication for benign prostate enlargement.

Treatment outcomes of detrusor underactivity in women based on clinical and videourodynamic characteristics.

Treatment of voiding dysfunction due to detrusor underactivity (DU) remains challenging. This study sought to determine the characteristics of video urodynamic study (VUDS) in female DU and outcomes after active treatment. A total of 409 female patients with VUDS-proven DU were recruited. All patients received conservative bladder management, with others receiving active treatment, such as oral medication, transurethral incision of bladder neck (TUI-BN), surgery for prolapse, and urethral botulinum toxin A (BoNT-A) injection, according to their VUDS characteristics. Treatment outcomes were then analyzed by different VUDS characteristics. Satisfactory treatment outcomes were noted in 123 patients (30.0%), among whom 35 and 88 had a VE of > 90% and > 66.7%, respectively. A total of 165 patients (40.3%) had voiding efficiency (VE) of 33.3-66.7%, whereas 121 (29.6%) remained unable to void (12.5%) or had a VE of < 33.3% (17.1%). Conservative treatment had the worst outcome. Patients with normal or slightly reduced bladder sensation (49.3%) and those with a post-void residual (PVR) of < 250mL (59.4%) displayed better satisfactory outcome after treatment; while TUI-BN and urethral BoNT-A injection promoted better treatment results. Patients with detrusor acontractility and a PVR of ≥ 500mL still achieved high VE rates (> 66.7%) after TUI-BN. A 56.3% satisfactory outcome was achieved after TUI-BN, whereas 58.1% satisfactory outcome was noted in those with a tight external sphincter after medical treatment. Female patients with DU exhibited VE improvement after active treatment. Patients with very low detrusor contractility and absent bladder sensation generally exhibited poor treatment outcomes.

Contemporary Outcomes after Transurethral Procedures for Bladder Neck Contracture Following Endoscopic Treatment of Benign Prostatic Hyperplasia.

Objectives: Bladder neck contracture (BNC) is a bothersome complication following endoscopic treatment for benign prostatic hyperplasia (BPH). The objective of our study was to give a more realistic insight into contemporary endoscopic BNC treatment and to evaluate and identify risk factors associated with inferior outcome. Material and Methods: We identified patients who underwent transurethral treatment for BNC secondary to previous endoscopic therapy for BPH between March 2009 and October 2016. Patients with vesico-urethral anastomotic stenosis after radical prostatectomy were excluded. Digital charts were reviewed for re-admissions and re-visits at our institutions and patients were contacted personally for follow-up. Our non-validated questionnaire assessed previous urologic therapies (including radiotherapy, endoscopic, and open surgery), time to eventual further therapy in case of BNC recurrence, and the modality of recurrence management. Results: Of 60 patients, 49 (82%) and 11 (18%) underwent transurethral bladder neck resection and incision, respectively. Initial BPH therapy was transurethral resection of the prostate (TURP) in 54 (90%) and holmium laser enucleation of the prostate (HoLEP) in six (10%) patients. Median time from prior therapy was 8.5 (IQR 5.3–14) months and differed significantly in those with (6.5 months; IQR 4–10) and those without BNC recurrence (10 months; IQR 6–20; p = 0.046). Thirty-three patients (55%) underwent initial endoscopic treatment, and 27 (45%) repeated endoscopic treatment for BNC. In initially-treated patients, time since BPH surgery differed significantly between those with a recurrence (median 7.5 months; IQR 6–9) compared to those treated successfully (median 12 months; IQR 9–25; p = 0.01). In patients with repeated treatment, median time from prior BNC therapy did not differ between those with (4.5 months; IQR 2–12) and those without a recurrence (6 months; IQR 6–10; p = 0.6). Overall, BNC treatment was successful in 32 patients (53%). The observed success rate of BNC treatment was significantly higher after HoLEP compared to TURP (100% vs. 48%; p = 0.026). Type of BNC treatment, number of BNC treatment, and age at surgery did not influence the outcome. Conclusions: A longer time interval between previous BPH therapy and subsequent BNC incidence seems to favorably affect treatment success of endoscopic BNC treatment, and transurethral resection and incision appear equally effective. Granted the relatively small sample size, BNC treatment success seems to be higher after HoLEP compared to TURP, which warrants validation in larger cohorts.

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety.

We aimed to evaluate the success of bladder neck injections of triamcinolone at the time of transurethral bladder neck incision (BNI) for prevention of recurrent vesicourethral anastomotic stenosis (VUAS) following prostate cancer treatment. This is a retrospective cohort study examining patients with recurrent VUAS post-radical prostatectomy (RP) ± radiation treated with triamcinolone injections at the time of BNI. VUAS was diagnosed by symptoms followed by cystoscopy or urethrography. The outpatient procedures were done under general anesthesia. Cold knife incisions were made at the three, nine, and 12 o'clock BN positions, followed by triamcinolone injections (4 mg/mL) into the three and nine o'clock incision sites. Treatment outcomes were determined with cystoscopy. Eighteen men underwent 25 procedures over a four-year period. Median age at diagnosis of VUAS was 65 (interquartile range [IQR] 61-68); median time to VUAS from RP was eight months (IQR 5-12). Fourteen patients (78%) had radiation treatment. The cohort had 128 unsuccessful VUAS treatments, with a median of five failed treatments per patient (IQR 3-10). Failed treatments included BN dilation, BNI, BN injection of mitomycin C, and urethral stent placement. Success rate after a mean of 16.3 months (standard deviation [SD] 8.1) from the time of triamcinolone injection was 83% (15/18). Six patients went on to have successful incontinence surgery. Five patients (28%) had treatment complications (bleeding, urinary tract infection, pain, and urinary extravasation). The three non-responders are stable and awaiting re-treatment with triamcinolone injection. Triamcinolone bladder neck injections for post-RP VUAS are a useful and safe treatment for recurrent stenosis.

Efficacy of Needle Electrode Three-Point Method on Bladder Neck Contracture After Transurethral Resection of the Prostate

Introduction: Benign prostate hyperplasia (BPH) is a common disease among the elderly, which is the major cause of lower urinary tract symptoms. Transurethral resection of the prostate (TURP) is widely used for the treatment of BPH. However, complications of urethral stricture and bladder neck contracture (BNC) occur postoperation that causes poor quality of life in patients. Reported incidence of BNC ranges from 0.3% to 9.6%.1,2 Bladder neck incision, laser vaporization, and balloon dilatation are applied for the treatment of BNC with overall high recurrence rates. In recent years, new techniques such as T-plasty, a modified YV-plasty, and robot-assisted laparoscopic Y-V plasty were performed in the treatment of BNC and achieved satisfactory outcomes with success rate of 83.3%–90%.3,4 However, these techniques are complicated and difficult for the primary urologists to master. This video shows a transurethral approach by using a needle electrode to incise the pathway from the bladder outlet to the proximal verumontanum at 5, 7, and 12 o'clock positions, respectively, the depth of the incision should reach the adipose layer. Materials and Methods: From February 2015 to August 2019, the bladder necks from 48 patients with BNC after TURP were incised by the needle electrode at the 5, 7, and 12 o'clock positions, which extended the incision from the bladder outlet to the proximal verumontanum until exposure of the adipose layer. During the whole procedure in the treatment of BNC including cut of the residual prostate scar tissue, three-point incision by the needle electrode was the most important for the treatment of BNC, which could be against the formation of fibrous rings and prevent the recurrence of BNC. Patient's preoperation properties, peri- and postsurgical data, such as time of operative, postsurgical bladder irrigation, catheter duration, and hospital stay, as well as data of the international prostate symptom score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR), were recorded 1 and 6 months after surgery. Results: All 48 cases of BNC were effectively treated in (49.6 ± 14.4) minutes with (15.1 ± 4.6) hours for postoperative bladder irrigation. The urethral catheter was withdrawn at (5.6 ± 2.4) days post-treatment. Only one case had dysuria after postoperative catheter removal, the other 47 cases on re-examination after 1 and 6 months showed that IPSS and PVR were significantly decreased, but Qmax was increased when compared with preoperation (p < 0.001). Importantly, there were no significantly different outcomes between 1 and 6 months postoperation (p > 0.05). Strikingly, 20 cases followed up 6–24 months, mean of 12 months, had no urinary incontinence, retrograde ejaculation, and recurrence of BNC. Conclusions: Transurethral incision of bladder neck by the three-point method using the needle electrode for the treatment of BNC is mini-invasive, safe, effective, and reliable and may be implemented in the clinical setting. No competing financial interests exist. Runtime of video: 6 mins 53 secs

Experience of transurethral incision of the bladder neck for female primary bladder neck obstruction

Objective To analyse and discuss the outcomes of female primary bladder neck obstruction(PBNO) with transurethral incision of the bladder neck(TUIBN). Methods From January 2004 to December 2013, 38 female patients who underwent transurethral incision of the bladder neck were retrospectively reviewed. The mean age of patients was 57.7 years and the duration of symptoms before diagnosis was 3.5 years. All patients presented with varying degree of difficulty of urination. There were 10 cases with lower abdominal discomfort and 20 cases with history of urinary infection. Preoperative examinations included physical examination, urine routine, international prostate symptom score (IPSS), quality of life (QOL), ultrasonography, urodynamics and cystoscopy. The urodynamic diagnostic criteria for PBNO were a maximum uroflow rate(Qmax) 20 cmH2O. All patients failed with 3-6 month alpha-blockers treatment and then underwent TUIBN. Results Follow-up data of all patients were available for 12-60 months (average 29.6) after operation. Successful recovery after operation was achieved in 33 of 38 (86.84 %). At the first year follow-up, the IPSS decreased from 26.63±3.15 to 13.00±7.18 (P<0.01), the Qmax increased from (8.65±1.32) ml/s to (15.91±3.89) ml/s (P<0.01), the postvoid residual decreased from (122.92±58.36) ml to (56.55±36.57) ml (P<0.01), and the Pdet.Qmax decreased from (52.18±7.31) cmH2O to (36.12±4.74) cmH2O (P<0.01), respectively. Of the 5 cases in which the first operation was not successful, 3 cases (7.89%) underwent an additional TUIBN 1 to 2 years after the initial operation and 2 cases detected bilateral renal hydronephrosis by B-ultrasound before operation underwent life-long catheter cystostomy. The second operation of 3 cases was successful. Pathological examinations revealed fibrous tissue hyperplasia with chronic inflammation in 32 cases, glandular cystitis in 4 cases and chronic inflammation with squmaors metaplasia in 2 cases. Conclusions The diagnosis of primary bladder neck obstruction in women is based on typical symptoms, urodynamics and cystoscopy. TUIBN is a safe and effective therapy for PBNO. Key words: Bladder neck obstruction; Transurethral; Voiding dysfunction

For smaller weight transurethral resection of prostate, combined transurethral incision of bladder neck is an independent factor for less urinary retention rate. – A nation-wide database study

For smaller weight transurethral resection of prostate, combined transurethral incision of bladder neck is an independent factor for less urinary retention rate. – A nation-wide database study

Functional and clinical outcome of ileal (Studer) neo-bladder reconstruction: single centre experience from Pakistan.

To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal (Studer) neo-bladder following radical cystectomy. Case series. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010. Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder (Studer type) reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients. A total of 29 patients (23 males and 6 females) with mean age of 59 ± 12 years were included for the final analysis. The mean duration of surgery (both radical cystectomy and urinary diversion) was 520 ± 70 minutes. Perioperative complication rate was 24% (n=7) with surgical site infection in 4 patients, sepsis in 1 patient and 2 had ureteroileal leak. At 6 months follow-up, 22 patients were fully continent while 7 patients had minimal stress / nocturnal incontinence. The continence rate was 93% (n=27) at one year follow-up. The mean capacity of neo-bladder at 6 months was 384 ± 66 mLs. The late complication rate was 17% (n=5). Three patients developed anastomotic stricture requiring transurethral incision of neo bladder neck, one formed stone in neo-bladder and one developed incision hernia. All patients had preserved renal functions on follow-up. The survival rate was 80% (n=23) at a median follow-up of 66.4 ± 36 months. Two patients developed local recurrence and four developed distant metastasis. Studer ileal neo-bladder is a safe and effective option for urinary diversion in select patients with good oncological and functional outcomes comparable to contemporary literature, even in a low volume center.

MP13-20 THE DEVASTATED URETHRA: OUR EXPERIENCE IN THE MANAGEMENT OF REFRACTORY POST-PROSTATE THERAPY URETHRAL STRICTURES

You have accessJournal of UrologyUrethra: Benign & Malignant Disease1 Apr 2014MP13-20 THE DEVASTATED URETHRA: OUR EXPERIENCE IN THE MANAGEMENT OF REFRACTORY POST-PROSTATE THERAPY URETHRAL STRICTURES Daniel Yanko, Kevin Carlson, Trafford Crump, Bryce Weber, and Richard Baverstock Daniel YankoDaniel Yanko More articles by this author , Kevin CarlsonKevin Carlson More articles by this author , Trafford CrumpTrafford Crump More articles by this author , Bryce WeberBryce Weber More articles by this author , and Richard BaverstockRichard Baverstock More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.689AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral strictures may develop from the treatment of both benign and malignant prostate etiologies and can be challenging to manage. We reviewed our local experience in managing refractory post-prostate therapy urethral strictures (PPUS) via a novel treatment pathway. METHODS We performed a retrospective analysis of all patients at our Centre diagnosed with a urethral stricture following various prostate therapies between May 2008 and October 2013. Multiple variables were assessed, including: initial diagnosis, method of stricture treatment and number of treatments. All patients underwent initial endoscopic management followed by a standardized self-catheterization program developed at our Centre. RESULTS Forty-six patients were identified with initial diagnoses of prostate cancer in 28 (61%) and benign prostatic hyperplasia (BPH) in 18 (39%). All patients underwent initial endoscopic management [direct visual internal urethrotomy (DVIU) or transurethral incision of bladder neck (TUIBN)] by us (38) and/or the referring urologist (8). In total, a mean of 1.50 (95%CI 1.22-1.78) endoscopic procedures were performed per patient. 41 (89%) patients were stabilized following endoscopic resection combined with a standardized self-dilation program. Five (11%) patients were refractory to the above measures and required more invasive treatment: 2 (4.3%) cystectomy with ileal conduit, 2 (4.3%) open vesicourethral anastamotic revision, 1 (2.2%) YV-plasty. All three patients who underwent open bladder neck reconstructive procedures remain with stable outlets at cystoscopic follow-up (6-48 months). CONCLUSIONS In our large cohort of refractory PPUS, we have demonstrated successful outcome in the majority of cases with minimal operative intervention. In select cases, a variety of reconstructive surgical procedures may be required. These observations support our novel simplified approach to these refractory patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e183 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Daniel Yanko More articles by this author Kevin Carlson More articles by this author Trafford Crump More articles by this author Bryce Weber More articles by this author Richard Baverstock More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Transurethral bladder neck incision in women with primary bladder neck obstruction

Bladder outlet obstruction is an uncommon condition in women. Primary bladder neck obstruction is one of the functional causes of bladder outlet obstruction. We evaluated surgical treatment in our patients with primary bladder neck obstruction. We retrospectively evaluated the medical data of 47 female patients from the Department of Urology who underwent transurethral incision of the bladder neck from January 2000 to December 2012. All patients underwent transurethral bladder neck incision at the vesical neck and proximal urethra at the 5- and 7-o'clock positions. We compared symptoms and urodynamic parameters before and after the operation. Out of 47 female patients who underwent the operation, primary bladder neck obstruction was diagnosed in 42. The mean age was 44.3 ± 16.8 (range: 21-78) years. The postoperative maximal flow rates were significantly increased (20.6 ± 3.9 vs. 7.6 ± 3.2mL/s, P < 0.0001), and the postvoid residual urine was decreased (31.3 ± 7.8 vs. 132.1 ± 22.24mL, P = 0.0002) compared with preoperative findings. Improvement was evident in most patients (83.3 %). A repeat operation had to be performed in seven patients (16.7 %). Operative therapy failed in one patient (2.4 %). The diagnosis of primary bladder neck obstruction in women is based on typical symptoms, uroflowmetry and multichannel urodynamics, including electromyography. Videourodynamics is obligatory in doubtful cases. Transurethral bladder neck incision is an effective therapy for female patients with primary bladder neck obstruction, and if necessary, a second procedure can be safely performed.

1967 SMALL RESECTED PROSTATE WEIGHT IS ASSOCIATED WITH A HIGHER REOPERATION RATE FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE íV A STUDY ON 33905 PATIENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (I)1 Apr 20131967 SMALL RESECTED PROSTATE WEIGHT IS ASSOCIATED WITH A HIGHER REOPERATION RATE FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE íV A STUDY ON 33905 PATIENTS Alex Tong Long Lin, Chih Chieh Lin, Hsiao Jen Chung, Eric Yi Hsiu Huang, Kuang Kuo Chen, and Tzeng Zi Chen Alex Tong Long LinAlex Tong Long Lin Taipei, Taiwan More articles by this author , Chih Chieh LinChih Chieh Lin Taipei, Taiwan More articles by this author , Hsiao Jen ChungHsiao Jen Chung Taipei, Taiwan More articles by this author , Eric Yi Hsiu HuangEric Yi Hsiu Huang Taipei, Taiwan More articles by this author , Kuang Kuo ChenKuang Kuo Chen Taipei, Taiwan More articles by this author , and Tzeng Zi ChenTzeng Zi Chen Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of the prostate (TURP) is a well accepted procedure for relieving prostate obstruction to improve lower urinary tract symptom (LUTS). We conducted this nation-wide study to investigate as if the resected prostate weight is a predictive factor for reoperation of TURP, transurethral incision of bladder neck (TUIBN), and urethrotomy. METHODS The subset of the National Health Insurance Research Database (NHIRD) of Taiwan contains data of all medical benefit claims and covers most Taiwan populations. According to the ICD codes-9, all patients with diagnostic codes, 600.X-602.X, and received TURP from 2006 to 2009. All patients with genitourinary cancers before TURP were excluded. The patients were excluded if the diagnosis of prostate cancer was recorded in one month after TURP. Owing to different benefit claims for different resected prostate weight, we could subdivide patients into three subgroups, small group (< 15 grams), medium group (15∼50 grams), large group (>50 grams). After first TURP, we recorded the incident rate and interval to following procedures. The relative risk between groups was further compared. RESULTS Among the total population of 22.8 millions, 33905 patients received TURP. The patient's number of each subgroups were 14511 (42.8%) in small group, 16487 (48.6%) in medium group, and 2907 (8.6%) in large group. The patients' number of reoperation in each subgroup (small, medium, large) were 663 (4.6%), 452 (2.7%), 90 (3.1%), respectively. The patients' number of receiving TUIBN in each subgroup were 183 (1.3%), 86 (0.5%), 5 (0.2%). The patients' number of receiving urethrotomy in each subgroup were 696(4.8%), 459 (2.8%), 63 (2.2%). The mean intervals of first TURP to reoperation of TURP, TUIBN, and urethrotomy were 1.39, 1.09, and 1.02 years, respectively. Relative risk of further surgical procedures after first TURP between each subgroup was detailed in the table 1. In the table, smaller group revealed higher risk to receive further surgical procedures. CONCLUSIONS This study found that a smaller resected weight could be a predictive factor for further procedures, reoperation, TUIBN, and urethrotomy after TURP. It's necessary to strictly evaluate the indication of TURP for patients with a smaller prostate. Table 1. The relative risk between groups was further compared by logistic regression model Odds Ratio 95% CI p value Reoperation Small v.s. Large 1.4 1.2-1.8 0.002 Medium v.s. Large 0.9 0.7-1.1 0.23 TUIBN Small v.s. Large 6.7 2.8-16.4 < 0.001 Medium v.s. Large 2.9 1.2-7.2 0.02 Urethrotomy Small v.s. Large 2.2 1.7-2.9 < 0.001 Medium v.s. Large 1.3 1.0-1.7 0.07 Adjust with demography Factors: age, urbanized level, geographic location © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e807-e808 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Tong Long Lin Taipei, Taiwan More articles by this author Chih Chieh Lin Taipei, Taiwan More articles by this author Hsiao Jen Chung Taipei, Taiwan More articles by this author Eric Yi Hsiu Huang Taipei, Taiwan More articles by this author Kuang Kuo Chen Taipei, Taiwan More articles by this author Tzeng Zi Chen Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of transurethral bladder neck incision with 2-micron continuous wave laser (RevoLix) for the management of bladder outlet stricture in women.

To report the short-term outcome of transurethral bladder neck incision with 2-micron continuous wave laser (RevoLix) in the management of bladder outlet stricture in women. In a prospective study, between January 2011 and February 2012, a total of 14 patients with the complaint of difficulty in voiding underwent transurethral bladder neck incision with 2-micron 120-W continuous wave laser (RevoLix) using low energy setting (24 W). Pre-operative investigations included international prostate symptom score (IPSS) and quality of life index evaluation, multi-channel urodynamic study, and urethrocystoscopy. Postoperative clinical and urodynamic improvement were compared with the pre-operative data. Of 14 patients, 4 and 10 subjects suffered from chronic urinary retention and difficulty in voiding, respectively. The mean age of the patients was 55.1 years (range, 40 to 67 years). Mean operation time and postoperative follow-up period were 23.8 minutes (range, 15 to 30 minutes) and 10.2 months (range, 6 to 18 months), respectively. Median IPSS improved significantly from 28 points at baseline to 11 points postoperatively (P = .005). Median quality of life score also improved from 4.2 points to 1.5 points (P = .005). None of the patients needed re-operation. Median post void residual urine decreased significantly after the procedure (101 mL versus 17 mL; P = .003). No significant complications and de-novo incontinence were noted in this study. Transurethral bladder neck incision with 2-micron continuous wave laser (RevoLix) may be used safely in the management of bladder outlet stricture in women with satisfactory short-term clinical outcomes.

Modified Transurethral Incision for Primary Bladder Neck Obstruction in Women: A Method to Improve Voiding Function Without Urinary Incontinence

To describe the modified surgical technique and report the long-term outcomes of modified transurethral incision for the treatment of primary bladder neck obstruction in women. A total of 30 women were diagnosed with primary bladder neck obstruction from the videourodynamic study findings according to the Blaivas-Groutz nomogram for female bladder outlet obstruction. Patients with neurogenic, traumatic, anatomic, or iatrogenic causes of obstruction were excluded. The transurethral incision of the bladder neck was performed in all patients, with the modification of incising at 4 different sites on the bladder neck, at the 3-, 6-, 9-, and 12-o'clock positions. The urodynamic results and clinical improvement in voiding symptoms were assessed before surgery and 3, 48, and 60 months after treatment. Follow-up data were available for 30 (100%), 28 (93%), and 25 (83%) of the 30 patients at 3, 48, and 60 months postoperatively, respectively. During the 5-year follow-up, the mean International Prostate Symptom Score decreased from 23.3 to 5.9. The mean quality of life scores decreased from 4.4 to 2.1. The mean peak urinary flow rate increased from 7.61 to 17.53 mL/s. The mean postvoid residual urine volume decreased from 185.11 to 28.75 mL. The mean voiding detrusor pressure decreased from 62.12 to 21.92 cm H2O. All 25 patients had improvement in both objective and subjective voiding functions 5 years after this modified treatment. Only 1 woman (3%) had mild stress incontinence postoperatively and was cured after the patient performed levator ani exercises. The modified transurethral bladder neck incision is effective in the long term in relieving voiding difficulties owing to primary bladder neck obstruction in women without urinary incontinence.

Transurethral Incision of the Bladder Neck Using KTP in the Treatment of Bladder Neck Obstruction in Women

Objectives: To study the results and complications of the potassium-titanyl-phosphate (KTP, green) laser during transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction. Methods: A total of 40 women (43–79 years of age) with obstruction were identified. Patients with neurogenic, traumatic, or iatrogenic causes of obstruction were excluded. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision with KTP was performed in all patients. Urodynamic results, clinical improvements in voiding symptoms, and volume of bleeding were assessed. Results: Of the 40 patients, 12 had chronic urinary retention and 28 had difficult micturition. The most common findings on urodynamic study were a high voiding pressure plus low flow rate and high urethral pressure. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Urodynamic study revealed decreased voiding pressure, post-void residual urine volume, and increased maximal flow rate. Conclusions: Transurethral incision of the bladder neck is effective in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction in women. KTP has great efficacy in the treatment of female voiding dysfunction due to bladder neck obstruction.

Transurethral Incision of Bladder Neck in Treatment of Bladder Neck Obstruction in Women

Transurethral Incision of Bladder Neck in Treatment of Bladder Neck Obstruction in Women