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Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections

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Abstract

Purpose

To present our preliminary experience in managing patients with highly recurrent bladder neck contractures (BNCs) after transurethral resection of the prostate (TURP).

Methods

Between February 2015 and March 2018, 28 patients with highly recurrent BNCs who had failed multiple prior to endoscopic treatments were managed with transurethral resection and intra- and post-operative triamcinolone acetonide injections. The scar tissue was resected to the circular fiber at the bladder neck, and triamcinolone acetonide (2 mL, 40 mg/mL) was injected at the incision sites (8 points) using a cystoscopic injection needle. The cystoscopy-guided injections were repeated every four weeks for total three times after surgery. The patients were followed up at 3, 6, 12 months after surgery, and in July–August 2019.

Results

The recurrent interval before the treatments was 2.2 ± 1.2 months, without any BNC recurrence in the first 12 weeks after transurethral resection. The urinary flow rate increased significantly and was maintained during the follow-up period. Adequate voiding function was reported in 25 of 28 patients at a median follow-up of 2.8 (1.7, 3.9) years. One of the three patients with decreased urinary flow rate had underactive detrusor and no BNC recurrence. The complications were mild and tolerable.

Conclusion

Transurethral resection of the scar tissue combined with intra- and post-operative triamcinolone acetonide injections resulted in a success rate of 92.9% in patients with highly recurrent BNC following TURP. It is a simple, safe, and effective treatment for highly recurrent BNCs.

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References

  1. Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50:969–979

    Article  Google Scholar 

  2. Puppo P, Bertolotto F, Introini C et al (2009) Bipolar transurethral resection in saline (TURis): outcome and complication rates after the first 1000 cases. J Endourol 23:1145–1149

    Article  Google Scholar 

  3. Lee YH, Chiu AW, Huang JK (2005) Comprehensive study of bladder neck contracture after transurethral resection of prostate. Urology 65:498–503

    Article  Google Scholar 

  4. Tascı AI, Ilbey YO, Tugcu V, Cicekler O, Cevik C, Zoroglu F (2011) Transurethral resection of the prostate with monopolar resectoscope: single-surgeon experience and long-term results of after 3589 procedures. Urology 78:1151–1155

    Article  Google Scholar 

  5. Tang Y, Li J, Pu C et al (2014) Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol 28:1107–1114

    Article  Google Scholar 

  6. Kovell RC, Terlecki RP (2015) Management strategies for post-prostatectomy bladder neck contractures. Curr Urol Rep 16:65

    Article  Google Scholar 

  7. Reiss CP, Rosenbaum CM, Becker A et al (2016) The T-plasty: a modified YV-plasty for highly recurrent bladder neck contracture after transurethral surgery for benign hyperplasia of the prostate: clinical outcome and patient satisfaction. World J Urol 34:1437–1442

    Article  CAS  Google Scholar 

  8. Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J (2014) Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol 24:435–443

    Article  Google Scholar 

  9. Kafka M, Collins V, Kamolz LP, Rappl T, Branski LK, Wurzer P (2017) Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: a systematic review. Wound Repair Regen 25:139–144

    Article  Google Scholar 

  10. Kant SB, van den Kerckhove E, Colla C, Tuinder S, van der Hulst RRWJ, Piatkowski de Grzymala AA (2018) A new treatment of hypertrophic and keloid scars with combined triamcinolone acetonide and verapamil: a retrospective study. Eur J Plast Surg 41:69–80

    Article  CAS  Google Scholar 

  11. Eltahawy E, Gur U, Virasoro R, Schlossberg SM, Jordan GH (2008) Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injection. BJU Int 102:796–798

    Article  Google Scholar 

  12. Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kodama R, Peterson AC, Reston J, Rourke K, Stoffel JT, Vanni AJ, Voelzke BB, Zhao L, Santucci RA (2017) Male urethral stricture: American Urological Association Guideline. J Urol 197:182–190

    Article  Google Scholar 

  13. Simhan J, Ramirez D, Hudak SJ, Morey AF (2014) Bladder neck contracture. Transl Androl Urol 3:214–220

    PubMed  PubMed Central  Google Scholar 

  14. Ramirez D, Simhan J, Hudak SJ, Morey AF (2013) Standardized approach for the treatment of refractory bladder neck contractures. Urol Clin N Am 40:371–380

    Article  Google Scholar 

  15. Lubahn JD, Zhao LC, Scott JF et al (2014) Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol 191:143–147

    Article  Google Scholar 

  16. Ramirez D, Zhao LC, Bagrodia A, Scott JF, Hudak SJ, Morey AF (2013) Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology 82:1430–1435

    Article  Google Scholar 

  17. Park R, Martin S, Goldberg JD, Lepor H (2001) Anastomotic strictures following radical prostatectomy: insights into incidence, effectiveness of intervention, effect on continence, and factors predisposing to occurrence. Urology 57:742–746

    Article  CAS  Google Scholar 

  18. Pansadoro V, Emiliozzi P (1999) Iatrogenic prostatic urethral strictures: classification and endoscopic treatment. Urology 53:784–789

    Article  CAS  Google Scholar 

  19. Kranz J, Reiss PC, Salomon G, Steffens J, Fisch M, Rosenbaum CM (2017) Differences in recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral stenosis and bladder neck stenosis. Front Surg 10:44

    Article  Google Scholar 

  20. Vanni AJ, Zinman LN, Buckley JC (2011) Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures. J Urol 186:156–160

    Article  CAS  Google Scholar 

  21. Redshaw JD, Broghammer JA, Smith TG 3rd et al (2015) Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS Study Group. J Urol 193:587–592

    Article  CAS  Google Scholar 

  22. Leventhal D, Furr M, Reiter D (2006) Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg 8:362–382

    Article  Google Scholar 

  23. Kaynar M, Gul M, Kucur M et al (2016) Necessity of routine histopathological evaluation subsequent to bladder neck contracture resection. Cent Eur J Urol 69:353–357

    Google Scholar 

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Funding

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Author notes

  1. Linlin Zhang and Sheng Liu are co-first authors.

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Xian Jiaotong University, Xian, 710061, Shaanxi, China

    Linlin Zhang, Sheng Liu, Kaijie Wu & Lin Yang

  2. Department of Dermatology, The First Affiliated Hospital of Xian Jiaotong University, Xian, 710061, Shaanxi, China

    Xin Mu

Authors
  1. Linlin Zhang
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  2. Sheng Liu
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  3. Kaijie Wu
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  4. Xin Mu
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  5. Lin Yang
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Contributions

LLZ: protocol/project development, data analysis. SL: data collection, data analysis. KJW: manuscript writing, data analysis. XM: protocol/project development. LY: protocol/project development, data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Lin Yang.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Zhang, L., Liu, S., Wu, K. et al. Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol 39, 527–532 (2021). https://doi.org/10.1007/s00345-020-03224-w

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  • DOI: https://doi.org/10.1007/s00345-020-03224-w

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