Current Urology Reports

, 18:79 | Cite as

Bladder Neck Contracture After Endoscopic Surgery for Benign Prostatic Obstruction: Incidence, Treatment, and Outcomes

  • Giulia Primiceri
  • Pietro Castellan
  • Michele Marchioni
  • Luigi Schips
  • Luca Cindolo
Benign Prostatic Hyperplasia (K McVary, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Benign Prostatic Hyperplasia


Purpose of Review

In recent years, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate. Nonetheless, complications are still frequently encountered and bladder neck contracture (BNC) is a well-described complication after endoscopic surgery for benign prostatic obstruction (BPO). Our aim is to review and discuss the contemporary incidence, the relevant treatment strategies, and their outcomes.

Recent Findings

Findings suggest that BNC is a common complication with an acceptably low incidence but can range in complexity. Most contractures were usually managed successfully with conservative measures; nevertheless, in patients with refractory BNC, various valuable management strategies were employed with different kinds of success and re-treatment rates.


In consideration of these challenging possibilities, the treatment of BNC requires a tailored approach with patient-specific management that can range from simple procedures to complex surgical reconstruction.


Bladder neck contracture Benign prostatic hyperplasia Bladder outlet obstruction Transurethral procedures Surgery Outcomes 



The authors thank Kimberlee Ann Manzi for the linguistic revision.

Compliance with Ethical Standards

Conflict of Interest

Giulia Primiceri, Pietro Castellan, Michele Marchioni, Luigi Schips, and Luca Cindolo each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67:1066–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67:1099–109.CrossRefPubMedGoogle Scholar
  3. 3.
    Tao H, Jiang YY, Jun Q, et al. Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate. Int Braz J Urol. 2016;42:302–11.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lin Y, Wu X, Xu A, et al. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol. 2016;34:1207–19.CrossRefPubMedGoogle Scholar
  5. 5.
    Cindolo L, Marchioni M, Emiliani E, et al. Bladder neck contracture after surgery for benign prostatic obstruction. Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2017;69:133–43.PubMedGoogle Scholar
  6. 6.
    Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified. BJU Int. 1999;83:227–37.CrossRefPubMedGoogle Scholar
  7. 7.
    Ahyai SA, Gilling P, Kaplan SA, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97.CrossRefPubMedGoogle Scholar
  8. 8.
    Al-Rawashdah SF, Pastore AL, Salhi YA, et al. Prospective randomized study comparing monopolar with bipolar transurethral resection of prostate in benign prostatic obstruction: 36-month outcomes. World J Urol. 2017; doi: 10.1007/s00345-017-2023-7.
  9. 9.
    Mamoulakis C, Skolarikos A, Schulze M, et al. Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int. 2012;109:240–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Tang Y, Li J, Pu C, et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol. 2014;28:1107–14.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Herrmann TR, Liatsikos EN, Nagele U, et al. EAU guidelines on laser technologies. Eur Urol. 2012;61:783–95.CrossRefPubMedGoogle Scholar
  12. 12.
    Petros S. The evolution of ktp laser vaporization of prostate. Yonsei Med J. 2008;49(2):189–99.CrossRefGoogle Scholar
  13. 13.
    Castellan P, Castellucci R, Schips L, et al. Safety, efficacy and reliability of 180-W GreenLight laser technology for prostate vaporization: review of the literature. World J Urol. 2015;33:599–607.CrossRefPubMedGoogle Scholar
  14. 14.
    Kang DH, Cho KS, Ham WS, et al. A systematic review and meta-analysis of functional outcomes and complications following the photoselective vaporization of the prostate and monopolar transurethral resection of the prostate. World J Mens Health. 2016;34:110–22.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Barbalat Y, Velez MC, Sayegh CI, et al. Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction. Ther Adv Urol. 2016;8:181–91.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Elkoushy MA, Elshal AM, Elhilali MM. Reoperation after holmium laser enucleation of the prostate for management of benign prostatic hyperplasia: assessment of risk factors with time to event analysis. J Endourol. 2015;29:797–804.CrossRefPubMedGoogle Scholar
  17. 17.
    Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2013;189:S141–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Elshal AM, Elmansy HM, Elhilali MM. Two laser ablation techniques for a prostate less than 60 mL: lessons learned 70 months after a randomized controlled trial. Urology. 2013;82:416–22.CrossRefPubMedGoogle Scholar
  19. 19.
    • Reiss CP, Rosenbaum CM, Becker A, et al. 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. 2016;34:1437–42. Description of the technique of T-plasty as a valuable treatment option for highly recurrent BNC compared to other more invasive techniques CrossRefPubMedGoogle Scholar
  20. 20.
    •• Parker DC, Simhan J. Management of complications after surgical outlet reduction for benign prostatic obstruction. Can J Urol. 2015;22(Suppl 1):88–92. A review where were examinated in-depth the contemporary treatment strategies for long term complications of surgical outlet reduction procedures PubMedGoogle Scholar
  21. 21.
    Ramirez D, Simhan J, Hudak SJ, et al. Standardized approach for the treatment of refractory bladder neck contractures. Urol Clin North Am. 2013;40:371–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Eltahawy E, Gur U, Virasoro R, et al. Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injection. BJU Int. 2008;102:796–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Redshaw JD, Broghammer JA, Smith TG 3rd, et al. Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS study group. J Urol. 2015;193:587–92.CrossRefPubMedGoogle Scholar
  24. 24.
    Young BW. The retropubic approach to vesical neck obstruction in children. Surg Gynecol Obstet. 1953;96:150–4.PubMedGoogle Scholar
  25. 25.
    • Kaynar M, Gul M, Kucur M, et al. Necessity of routine histopathological evaluation subsequent to bladder neck contracture resection. Cent European J Urol. 2016;69:353–7. This document indicated that in the absence of previous risk factors (T3 or T4 stage PCa or bladder tumor), routine histological evaluation of bladder neck specimens is not necessary. PubMedPubMedCentralGoogle Scholar
  26. 26.
    Herschorn S, Elliott S, Coburn M, et al. SIU/ICUD consultation on urethral strictures: posterior urethral stenosis after treatment of prostate cancer. Urology. 2014;83:S59–70.CrossRefPubMedGoogle Scholar
  27. 27.
    Altay B, Erkurt B, Kiremit MC, et al. 180-W XPS GreenLight laser vaporization for benign prostate hyperplasia: 12-month safety and efficacy results for glands larger than 80 mL. Lasers Med Sci. 2015;30:317–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Guo S, Muller G, Lehmann K, et al. The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-left study. Lasers Med Sci. 2015;30:1147–51.CrossRefPubMedGoogle Scholar
  29. 29.
    Thomas JA, Tubaro A, Barber N, et al. A multileft randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol. 2016;69:94–102.CrossRefPubMedGoogle Scholar
  30. 30.
    Netsch C, Bach T, Pohlmann L, et al. Comparison of 120–200 W 2 μm thulium:yttrium-aluminum-garnet vapoenucleation of the prostate. J Endourol. 2012;26:224–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Netsch C, Pohlmann L, Herrmann TR, et al. 120-W 2-μm thulium:yttrium-aluminium-garnet vapoenucleation of the prostate: 12-month follow-up. BJU Int. 2012;110:96–101.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Giulia Primiceri
    • 1
  • Pietro Castellan
    • 2
  • Michele Marchioni
    • 1
  • Luigi Schips
    • 2
  • Luca Cindolo
    • 2
  1. 1.Department of UrologyUniversity G. D’AnnunzioChietiItaly
  2. 2.Department of UrologyASL02 AbruzzoChietiItaly

Personalised recommendations