Bladder neck incision using a 70 W 2 micron continuous wave laser (RevoLix)

Abstract

Postoperative bladder neck contracture continues to be a frequently occurring problem. Bladder neck incision (BNI) continues to be the standard mode of treatment. However, the recurrence rate appears to be high. Therefore alternative treatment options are still needed. We report about initial experience with the RevoLix 2 micron continuous wave laser for BNI after a 1-year follow-up. Fourteen patients with a second or third recurrence of bladder neck contracture after primary surgery were included into the trial. All patients reported high-grade obstruction and residual urine. BNI was performed using a 70 W 2-micron continuous wave laser (RevoLix). This laser utilizes the thulium as an active ion. Laser incisions were applied in 5 and 7o'clock lithotomy position. Remaining tissue was vaporized. Assessed outcomes were improvement in AUA-symptom-score, quality of life index and uroflowmetry, measured preoperatively, after 2 and 12 months postoperatively. Mean operating time was 7 min, mean catheterization time was 6.5 h. The mean maximum uroflow-rate improved from 9 ml/s preoperatively to 23 ml/s. AUA-symptom score improved from 22 to 8 points and quality of life index improved from four to one. Two patients developed restenosis so far. Although longer follow-up and larger sample size are needed, BNI with the RevoLix laser is a fast, safe and promising procedure in recurrent bladder neck sclerosis.