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Management of Bladder Neck Contractures in the Elderly

  • Geriatric Urology (TJ Guzzo and DJ Canter, Section Editors)
  • Published:
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Abstract

Prostate surgery for benign and malignant disease is common in the male patient greater than 60 years of age. Bladder neck contracture (BNC), a well-known complication following surgical treatment of the prostate, can range from simple lesions to complex, recalcitrant contractures that are refractory to multiple treatment modalities. The treatment of BNCs can thus vary from straightforward, office-based interventions to complex surgical reconstructions. Although numerous treatments have been described as an initial management strategy for patients with this condition, management of refractory cases requires a highly tailored approach. We review here the various therapeutic maneuvers used for the management of BNC in elderly patients.

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References

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

  1. Cooperberg MR, Moul JW, Carroll PR. The changing face of prostate cancer. J Clin Oncol: Off J Am Soc Clin Oncol. 2005;23:8146–51.

    Article  Google Scholar 

  2. Breyer BN, Davis CB, Cowan JE, Kane CJ, Carroll PR. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. 2010;106:1734–8. This important series assesses rates of bladder neck stenoses after minimally invasive and open approaches to prostatectomy.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Msezane LP, Reynolds WS, Gofrit ON, Shalhav AL, Zagaja GP, Zorn KC. Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function. J Endourol. 2008;22:97–104.

    PubMed  Google Scholar 

  4. Carlsson S, Nilsson AE, Schumacher MC, Jonsson MN, Volz DS, Steineck G, et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the karolinska university hospital, sweden. Urology. 2010;75:1092–7.

    Article  PubMed  Google Scholar 

  5. Brodak M, Kosina J, Pacovsky J, Navratil P, Holub L. Bipolar transurethral resection of anastomotic strictures after radical prostatectomy. J Endourol. 2010;24:1477–81.

    Article  PubMed  Google Scholar 

  6. Carr LK, Webster GD. Endoscopic management of the obliterated anastomosis following radical prostatectomy. The J Urol. 1996;156:70–2.

    Article  CAS  Google Scholar 

  7. Dalkin BL. Endoscopic evaluation and treatment of anastomotic strictures after radical retropubic prostatectomy. The J Urol. 1996;155:206–8.

    Article  CAS  Google Scholar 

  8. Giannarini G, Manassero F, Mogorovich A, Valent F, De Maria M, Pistolesi D, et al. Cold-knife incision of anastomotic strictures after radical retropubic prostatectomy with bladder neck preservation: efficacy and impact on urinary continence status. Eur Urol. 2008;54:647–56.

    Article  PubMed  Google Scholar 

  9. Kostakopoulos A, Argiropoulos V, Protogerou V, Tekerlekis P, Melekos M. Vesicourethral anastomotic strictures after radical retropubic prostatectomy: the experience of a single institution. Urol Int. 2004;72:17–20.

    Article  PubMed  Google Scholar 

  10. Ramchandani P, Banner MP, Berlin JW, Dannenbaum MS, Wein AJ. Vesicourethral anastomotic strictures after radical prostatectomy: efficacy of transurethral balloon dilation. Radiology. 1994;193:345–9.

    CAS  PubMed  Google Scholar 

  11. Borboroglu PG, Sands JP, Roberts JL, Amling CL. Risk factors for vesicourethral anastomotic stricture after radical prostatectomy. Urology. 2000;56:96–100.

    Article  CAS  PubMed  Google Scholar 

  12. Geary ES, Dendinger TE, Freiha FS, Stamey TA. Incontinence and vesical neck strictures following radical retropubic prostatectomy. Urology. 1995;45:1000–6.

    Article  CAS  PubMed  Google Scholar 

  13. Gillitzer R, Thomas C, Wiesner C, Jones J, Schmidt F, Hampel C, et al. Single center comparison of anastomotic strictures after radical perineal and radical retropubic prostatectomy. Urology. 2010;76:417–22.

    Article  PubMed  Google Scholar 

  14. Mark S, Perez LM, Webster GD. Synchronous management of anastomotic contracture and stress urinary incontinence following radical prostatectomy. The J Urol. 1994;151:1202–4.

    CAS  Google Scholar 

  15. Surya BV, Provet J, Johanson KE, Brown J. Anastomotic strictures following radical prostatectomy: risk factors and management. The J Urol. 1990;143:755–8.

    CAS  Google Scholar 

  16. Hall EJ, Astor M, Bedford J, Borek C, Curtis SB, Fry M, et al. Basic radiobiology. Am J Clin Oncol. 1988;11:220–52.

    Article  CAS  PubMed  Google Scholar 

  17. Turina M, Mulhall AM, Mahid SS, Yashar C, Galandiuk S. Frequency and surgical management of chronic complications related to pelvic radiation. Arch Surg. 2008;143:46–52. discussion 52.

    Article  PubMed  Google Scholar 

  18. Davidson PJ, van den Ouden D, Schroeder FH. Radical prostatectomy: prospective assessment of mortality and morbidity. Eur Urol. 1996;29:168–73.

    CAS  PubMed  Google Scholar 

  19. Wang R, Wood Jr DP, Hollenbeck BK, Li AY, He C, Montie JE, et al. Risk factors and quality of life for post-prostatectomy vesicourethral anastomotic stenoses. Urology. 2012;79:449–57. This single-institution analysis describes risk factors for bladder neck contracture in a large series of patients undergoing radical prostatectomy.

    Article  PubMed  Google Scholar 

  20. Erickson BA, Meeks JJ, Roehl KA, Gonzalez CM, Catalona WJ. Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience. BJU Int. 2009;104:1615–9.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM. Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy. The J Urol. 2005;174:135–9. discussion 139.

    Article  Google Scholar 

  22. Kim HS, Cho MC, Ku JH, Kim SW, Paick JS. The efficacy and safety of photoselective vaporization of the prostate with a potassium-titanyl-phosphate laser for symptomatic benign prostatic hyperplasia according to prostate size: 2-year surgical outcomes. Korean J Urol. 2010;51:330–6.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Malde S, Rajagopalan A, Patel N, Simoes A, Choi W, Shrotri N. Potassium-titanyl-phosphate laser photoselective vaporization for benign prostatic hyperplasia: 5-year follow-up from a district general hospital. J Endourol. 2012;26:878–83.

    Article  PubMed  Google Scholar 

  24. Sandhu JS, Ng C, Vanderbrink BA, Egan C, Kaplan SA, Te AE. High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates. Urology. 2004;64:1155–9.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Puppo P, Bertolotto F, Introini C, Germinale F, Timossi L, Naselli A. Bipolar transurethral resection in saline (turis): outcome and complication rates after the first 1000 cases. J Endourol. 2009;23:1145–9.

    Article  PubMed  Google Scholar 

  27. Ramirez D, Zhao LC, Bagrodia A, Scott JF, Hudak SJ, Morey AF. Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology. 2013;82(6):1430–5. This is a novel experience with long-term follow-up that analyzes a hybrid procedure involving both endoscopic dilation and incision in the management of bladder neck contracture.

    Article  PubMed  Google Scholar 

  28. Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR. Incidence of urethral stricture after primary treatment for prostate cancer: data from capsure. The J Urol. 2007;178:529–34. discussion 534.

    Article  Google Scholar 

  29. Marks LB, Carroll PR, Dugan TC, Anscher MS. The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys. 1995;31:1257–80.

    Article  CAS  PubMed  Google Scholar 

  30. Moreira Jr SG, Seigne JD, Ordorica RC, Marcet J, Pow-Sang JM, Lockhart JL. Devastating complications after brachytherapy in the treatment of prostate adenocarcinoma. BJU Int. 2004;93:31–5.

    Article  PubMed  Google Scholar 

  31. Zelefsky MJ, Whitmore Jr WF. Long-term results of retropubic permanent 125iodine implantation of the prostate for clinically localized prostatic cancer. The J Urol. 1997;158:23–9. discussion 29–30.

    Article  CAS  Google Scholar 

  32. Nguyen PL, D’Amico AV, Lee AK, Suh WW. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: a systematic review of the literature. Cancer. 2007;110:1417–28.

    Article  PubMed  Google Scholar 

  33. Park R, Martin S, Goldberg JD, Lepor H. Anastomotic strictures following radical prostatectomy: Insights into incidence, effectiveness of intervention, effect on continence, and factors predisposing to occurrence. Urology. 2001;57:742–6.

    Article  CAS  PubMed  Google Scholar 

  34. Besarani D, Amoroso P, Kirby R. Bladder neck contracture after radical retropubic prostatectomy. BJU Int. 2004;94:1245–7.

    Article  PubMed  Google Scholar 

  35. Lubahn JD, Zhao LC, Scott JF, Hudak SJ, Chee J, Terlecki R, et al. Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. The J Urol. 2013;20(3):6773–7. This report is a multi-institutional series of surveyed patients on a self-dilation regimen for urethral/bladder neck stricture. Unlike patients on intermittent catheterization, this study demonstrates that patients on dilation regimens have a poor quality of life.

    Google Scholar 

  36. Anger JT, Raj GV, Delvecchio FC, Webster GD. Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management. The J Urol. 2005;173:1143–6.

    Article  Google Scholar 

  37. Yurkanin JP, Dalkin BL, Cui H. Evaluation of cold knife urethrotomy for the treatment of anastomotic stricture after radical retropubic prostatectomy. The J Urol. 2001;165:1545–8.

    Article  CAS  Google Scholar 

  38. Pansadoro V, Emiliozzi P. Iatrogenic prostatic urethral strictures: classification and endoscopic treatment. Urology. 1999;53:784–9.

    Article  CAS  PubMed  Google Scholar 

  39. Ramirez D, Simhan J, Hudak SJ, Morey AF. Standardized approach for the treatment of refractory bladder neck contractures. The Urol Clin N Am. 2013;40:371–80. This is a comprehensive review of refractory bladder neck contracture with detailed algorithms for management.

    Article  Google Scholar 

  40. Milroy EJ, Chapple CR, Cooper JE, Eldin A, Wallsten H, Seddon AM, et al. A new treatment for urethral strictures. Lancet. 1988;1:1424–7.

    Article  CAS  PubMed  Google Scholar 

  41. Elliott DS, Boone TB. Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. The J Urol. 2001;165:413–5.

    Article  CAS  Google Scholar 

  42. Corujo M, Badlani GH. Epithelialization of permanent stents. J Endourol. 1997;11:477–80.

    Article  CAS  PubMed  Google Scholar 

  43. Beier-Holgersen R, Brasso K, Nordling J, Andersen JT. The “wallstent”: a new stent for the treatment of urethral strictures. Scand J Urol Nephrol. 1993;27:247–50.

    Article  CAS  PubMed  Google Scholar 

  44. Morgia G, Saita A, Morana F, Macaluso CP, Serretta V, Lanza P, et al. Endoprosthesis implantation in the treatment of recurrent urethral stricture: a multicenter study. Sicilian-calabrian urology society. J Endourol. 1999;13:587–90.

    Article  CAS  PubMed  Google Scholar 

  45. De Vocht TF, van Venrooij GE, Boon TA. Self-expanding stent insertion for urethral strictures: a 10-year follow-up. BJU Int. 2003;91:627–30.

    Article  PubMed  Google Scholar 

  46. Hussain M, Greenwell TJ, Shah J, Mundy A. Long-term results of a self-expanding wallstent in the treatment of urethral stricture. BJU Int. 2004;94:1037–9.

    Article  PubMed  Google Scholar 

  47. Badlani GH, Press SM, Defalco A, Oesterling JE, Smith AD. Urolume endourethral prosthesis for the treatment of urethral stricture disease: long-term results of the north american multicenter urolume trial. Urology. 1995;45:846–56.

    Article  CAS  PubMed  Google Scholar 

  48. Chancellor MB, Gajewski J, Ackman CF, Appell RA, Bennett J, Binard J, et al. Long-term followup of the north american multicenter urolume trial for the treatment of external detrusor-sphincter dyssynergia. The J Urol. 1999;161:1545–50.

    Article  CAS  Google Scholar 

  49. Magera Jr JS, Inman BA, Elliott DS. Outcome analysis of urethral wall stent insertion with artificial urinary sphincter placement for severe recurrent bladder neck contracture following radical prostatectomy. The J Urol. 2009;181:1236–41. This is a retrospective analysis that demonstrates improved quality of life for patients undergoing staged bladder neck stenting with artificial urinary sphincter placement.

    Article  Google Scholar 

  50. Erickson BA, McAninch JW, Eisenberg ML, Washington SL, Breyer BN. Management for prostate cancer treatment related posterior urethral and bladder neck stenosis with stents. The J Urol. 2011;185:198–203. This retrospective series of prostate cancer patients with posterior urethral stenoses demonstrates UroLume stenting as a reasonable option in patients that are unable to undergo open reconstruction.

    Article  Google Scholar 

  51. Schlossberg S, Jordan G, Schellhammer P. Repair of obliterative vesicourethral stricture after radical prostatectomy: a technique for preservation of continence. Urology. 1995;45:510–3.

    Article  CAS  PubMed  Google Scholar 

  52. Theodoros C, Katsifotis C, Stournaras P, Moutzouris G, Katsoulis A, Floratos D. Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures. Eur Urol. 2000;38:734–40. discusssion 740–731.

    Article  CAS  PubMed  Google Scholar 

  53. Wessells H, Morey AF, McAninch JW. Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: Reconstructive armamentarium. The J Urol. 1998;160:1373–5.

    Article  CAS  Google Scholar 

  54. Simonato A, Gregori A, Lissiani A, Carmignani G. Two-stage transperineal management of posterior urethral strictures or bladder neck contractures associated with urinary incontinence after prostate surgery and endoscopic treatment failures. Eur Urol. 2007;52:1499–504.

    Article  PubMed  Google Scholar 

  55. Mundy AR, Andrich DE. Posterior urethral complications of the treatment of prostate cancer. BJU Int. 2012;110:304–25. This is a comprehensive review on the treatment of prostate cancer-related bladder neck contracture, urethral stricture, and urorectal fistula.

    Article  PubMed  Google Scholar 

  56. Reiss P, Pfalzgraf D, Kluth L, Isbarn H, Balzer O, Meyer-Moldenhauer W-H, et al. Perineal-reanastomosis for the treatment of recurrent anastomotic strictures: outcome and patient satisfaction (abstract). The J Urol. 2011;185:e84.

    Article  Google Scholar 

  57. Eltahawy E, Gur U, Virasoro R, Schlossberg SM, Jordan GH. Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injection. BJU Int. 2008;102:796–8.

    Article  PubMed  Google Scholar 

  58. Vanni AJ, Zinman LN, Buckley JC. Radial urethrotomy and intralesional mitomycin c for the management of recurrent bladder neck contractures. The J Urol. 2011;186:156–60. This is a retrospective review of a novel treatment incorporating intralesional mitomycin C combined with urethrotomy for the treatment of recurrent bladder neck contracture.

    Article  CAS  Google Scholar 

  59. Hou JC, Landas S, Wang CY, Shapiro O. Instillation of mitomycin c after transurethral resection of bladder cancer impairs wound healing: an animal model. Anticancer Res. 2011;31:929–32.

    PubMed  Google Scholar 

  60. Doherty AP, Trendell-Smith N, Stirling R, Rogers H, Bellringer J. Perivesical fat necrosis after adjuvant intravesical chemotherapy. BJU Int. 1999;83:420–3.

    Article  CAS  PubMed  Google Scholar 

  61. Oddens JR, van der Meijden AP, Sylvester R. One immediate postoperative instillation of chemotherapy in low risk ta, t1 bladder cancer patients. Is it always safe? Eur Urol. 2004;46:336–8.

    Article  CAS  PubMed  Google Scholar 

  62. Moran DE, Moynagh MR, Alzanki M, Chan VO, Eustace SJ. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound. Skelet Radiol. 2012;41:1317–8.

    Article  Google Scholar 

  63. Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. The J Urol. 2004;172:2227–31.

    Article  Google Scholar 

  64. Lepor H, Kaci L. The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments. The J Urol. 2004;171:1216–9.

    Article  Google Scholar 

  65. Sacco E, Prayer-Galetti T, Pinto F, Fracalanza S, Betto G, Pagano F, et al. Urinary incontinence after radical prostatectomy: Incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. BJU Int. 2006;97:1234–41.

    Article  PubMed  Google Scholar 

  66. Sanderson KM, Penson DF, Cai J, Groshen S, Stein JP, Lieskovsky G, et al. Salvage radical prostatectomy: quality of life outcomes and long-term oncological control of radiorecurrent prostate cancer. The J Urol. 2006;176:2025–31. discussion 2031–2022.

    Article  Google Scholar 

  67. Stephenson AJ, Scardino PT, Bianco Jr FJ, DiBlasio CJ, Fearn PA, Eastham JA. Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy. The J Urol. 2004;172:2239–43.

    Article  Google Scholar 

  68. Borawski K, Webster G. Long term consequences in the management of the devastated, obstructed outlet using combined urolume stent with subsequent artificial urinary sphincter placement (abstract). The J Urol. 2010;183:e427.

    Article  Google Scholar 

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Jay Simhan, Jordan Siegel, and Allen F. Morey declare that they have no conflict of interest.

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  1. Department of Urology, UT Southwestern, Moss Bldg, 8th Fl, Ste 112, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA

    Jay Simhan & Allen F. Morey

  2. Department of Urology, UC Irvine Medical Center, 333 City Blvd. West, Suite 2100, Orange, CA, 92868, USA

    Jordan Siegel

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  1. Jay Simhan
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Correspondence to Jay Simhan.

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Simhan, J., Siegel, J. & Morey, A.F. Management of Bladder Neck Contractures in the Elderly. Curr Geri Rep 3, 26–32 (2014). https://doi.org/10.1007/s13670-013-0074-1

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