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. 2017 Apr;10(1):32-39.
doi: 10.1159/000447148. Epub 2017 Mar 30.

Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations

Shieh L Bang  1 , Sachin Yallappa  1 , Fatima Dalal  1 , Yahia Z Almallah  2
Affiliations

Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations

Shieh L Bang et al. Curr Urol. 2017 Apr.

Abstract

Objectives: To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature.

Materials and methods: Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended.

Results: The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m2. Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months (range 2-33 months).

Conclusion: Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.

Keywords: Artificial urinary sphincter; Bladder neck contracture; Incontinence; Prostatectomy; Sling.

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Figures

Fig. 1
Fig. 1
Our approach to management of PPI with concomitant BNC (Thomas King and Y. Zaki Almallah, “Post-Radical-Prostatectomy Urinary Incontinence: The Management of Concomitant Bladder Neck Contracture”, DOI: 10.1155/2012/295798.
Fig. 2
Fig. 2
a Results of Independent Samples t-test of average “BNI Times” for “Age (>/< 68) groups”. b Results of Pearson's Test of Linear Correlation for “BNI Times” vs “BMI”. c Results of Independent Samples t-test of average “BNI Times” for “Open” vs “Lap”. d Results of Independent Samples t-test of average “BNI Times” for “No RT” vs. “RT”. BNI = Bladder neck incision; BMI =body mass index; RT = radiotherapy.
See this image and copyright information in PMC

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