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【Objective】 To evaluate the efficacy and safety of 450 nm semiconductor blue laser combined with triamcinolone acetonide injection in the treatment of bladder neck contracture (BNC). 【Methods】 A 61-year-old male patient with BNC and urethral stricture was treated with 450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection. The surgery was performed with a small-caliber laser resectoscope of F22. The follow-up results 3 months after surgery were reported. 【Results】 The operation was successful, the operation time was 30 minutes, and the patient was discharged the next day after operation. Follow-up 3 months after operation showed the maximum urinary flow rate (Qmax) was 22.1 mL/s, the International Prostate Symptom Score (IPSS) was 2, the Quality of Life Scale (QoL) was 0, and no recurrence was observed. 【Conclusion】 It is safe and feasible to use 450 nm semiconductor blue laser combined with triamcinolone acetonide injection to treat bladder neck contracture through a small-caliber laser resectoscope of F22, especially for patients with urethral stricture. The short-term efficacy is satisfactory.
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Objective:To investigate the efficacy and safety of bladder neck resection combined with multipoint injection of triamcinolone acetonide in the treatment of bladder neck contractures (BNC) after transurethral resection prostate (TURP).Methods:The data of 25 patients with BNC after TUPR who underwent transurethral surgery in West China Hospital of Sichuan University from July 2019 to November 2021 were retrospectively analyzed, and the patients were divided into 2 groups according to the treatment method. There were 15 cases in the steroid injection group, with an average age of (67.5±8.8) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time after TURP was (21.9±29.1) months, the preoperative International Prostate Symptom Score (IPSS) was (30.0±3.5) points, quality of life (QOL) score was (5.7±0.5) points. There were 10 cases in the non-steroid injection group, with an average age of (65.2±10.5) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time of TURP was (29.3±33.5) months, and the preoperative IPSS was (30.4±2.6) points, QOL score was (5.8±0.4) points. There was no significant difference between the two groups ( P>0.05). In the steroid injection group, bladder neck resection combined with multipoint injection of triamcinolone acetonide was performed. The patients were in the lithotomy position, and a scope was placed through the urethra into the distal end of the narrow urethra under direct vision for observation, and a supersmooth guide wire was placed. The narrow section is then incised at 6 o'clock. After replacing the resectoscope, the urethral stricture scar was excised until the normal tissue of the bladder neck was exposed. Hemostasis by electrocoagulation resulted in no active bleeding from the urethra after resection. After the bladder injection needle was inserted, 80 mg (12 ml) of triamcinolone acetonide injection was injected in 6 equally spaced needles at the direction of the bladder neck from 3 to 9 o'clock. A supersmooth guide wire was placed, and a three-channel silicone urinary catheter was indwelled along the guide wire. The non-steroid injection group underwent simple bladder neck resection. Re-examination of urethroscopy at 3 and 6 months after operation showed that the patient had obvious dysuria and the microscopic examination showed that the recurrence of bladder neck stenosis was defined as the recurrence of stenosis. The efficacy, complications, and recurrence-free survival rates of the two groups were compared. Predictors of postoperative BNC recurrence were analyzed. Results:The operations in both groups were successfully completed. The operation time of the steroid injection group and the non-steroid injection group were (36.0±17.8) min and (48.5±57.9) min respectively ( P=0.438), and the intraoperative blood loss was (1.9±3.0) ml and (12.0±31.1) ml ( P=0.221)respectively. The length of hospital stay was (5.8±1.2) d and (4.4±2.5) d, respectively ( P=0.070). There was 1 case of transient hematuria and 1 case of epididymitis in the steroid injection group, and 1 case of transient hematuria and 1 case of transient dysuria in the non-steroid injection group ( P>0.05), all of which were relieved after symptomatic treatment. The IPSS of steroid injection group and non-steroid injection group were (11.0±5.6) points and (12.4±3.9) points at 3 months after operation, and (10.1±4.9) points and (14.7±7.7) points at 6 months after operation, respectively. QOL at 3 months after operation was (1.7±1.2) points and (2.1±1.5) points, respectively, and at 6 months after operation, it was (1.5±1.3) points and (3.0±2.0) points, respectively. There was statistical significance ( P<0.05). There were 1 case and 2 cases of recurrence in the steroid injection group and non-steroid injection group at 3 months after operation ( P=0.543), and 1 case and 5 cases at 6 months after operation ( P=0.023). The difference in survival curve between the two groups was statistically significant ( P=0.013). Combined steroid therapy ( OR=14.000, 95% CI1.299-150.889, P=0.030), time after scar resection ( OR=1.138, 95% CI1.017-1.273, P=0.025), postoperative IPSS( OR=1.302, 95% CI1.018-1.666, P=0.036), postoperative QOL score ( OR=4.280, 95% CI1.523-12.030, P=0.006) were the predictors of stenosis recurrence 6 months after surgery. Conclusion:Bladder neck scar resection combined with steroid injection could be safe and effective in the treatment of BNC after TURP, and local steroid injection may help reduce the recurrence rate of postoperative stenosis.
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Objective To investigate the effect of selectiveα1 adrenergic receptor blocking agent in the treatment of bladder neck contracture caused by refractory urinary tract infection in elder.Methods 70 cases of bladder neck contracture were selected and randomly divided into two groups, 35 cases each.Two groups received Ceftriaxone sodium 1 g qd at acute episode,Levofloxacin Hydrochloride 0.5 g tid at non acute phase,control group received the treatment of urethral dilatation, Terazosin hydrochloride 10 mg qd, the experiment group received more with Tamsulosin Hydrochloride Sustained 0.2 mg qd.Two groups were both treated for four weeks.Urinary dynamics index, international prostate symptom score,quality of life score, clinical symptom disappearance time, the number of daily spasm and adverse reactions were compared.Results After treatment, the total effective rate in the experiment group(94.29%) was higher than the control group(65.71%)(P<0.05).Maximum and the average urinary flow rates in two groups increased after treatment(P<0.05), residual urine volume, maximum urethral closure pressure decreased(P<0.05), international prostate symptoms and quality of life score decreased(P<0.05); and compared with the control group, maximum and the average urinary flow rates in the experiment group were higher(P<0.05), residual urine volume, maximum urethral closure pressure were lower(P<0.05), international prostate symptoms and quality of life score were lower(P<0.05), and the average duration of symptoms of bladder neck spasm and the number of daily spasm in the experiment group were significantly shorter than the control group ( P <0.05 ).There was no significant difference in adverse reactions between the two groups. Conclusion Selectiveα1 adrenergic receptor blocking agent in the treatment of bladder neck contracture caused by refractory urinary tract infection in elder was effective, and it can improve the patient's urine flow rate, reduce the residual urine level, increase the quality of life.
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Objective To investigate the clinical efficacy of modified YV-plasty for refractory bladder neck contracture (BNC) caused by transurethral resection of prostate (TURP).Methods From June 2013 to March 2016,11 patients with BNCs secondary to TURP were included in this study.Their mean age was 63.7 years (range,56-73 years).All patients presented voiding difficulty and failed after 2 or more prior endoscopic treatments.Modified YV-reconstruction of bladder neck was performed,by incising the anterior wall of bladder neck in a T-shaped manner,and creating two well-vascularized and tension-free flaps,which offer the possibility to reconstruct a wide bladder neck.Results After a mean follow-up of 14.6 months (ranging 3-24 months),successful outcome was achieved in 9 patients without incontinence secondary by surgery.Recurrent voiding difficulty developed in 2 patients,which was cured after a following endoscopic treatment.Conclusion A wider bladder neck can be obtained through modified YV-reconstruction of bladder neck,while avoiding external urethral sphincter injury.It is an available option for refractory bladder neck contracture.
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Objective To investigate the clinical efficacy of RevoLix 2 μm continuous wave laser treatment on bladder neck contracture after benign prostatic hyperplasia operation. Methods A total of 21 cases were enrolled in current research and they all accepted 2 μm continuous wave laser treatment of bladder neck contracture after benign prostatic hyperplasia operation in the 252th Hospital of the Chinese People's Liberation Army. The clinical efficacy was recorded. Results The operation of the 2 μm continuous wave laser vaporesections were successfully performed on 21 cases. The maximum urine flow rate was increased from(6. 86 ± 1. 97)ml/ s to(16. 31 ± 1. 61)ml/ s,and the difference was significant(t = 15. 49,P < 0. 01). After 3 to 23 months(median 14 months)follow-up,20 cases were cured and 1 case was combined with bladder residual urine 110 ml. Conclusion The therapy of 2 μm continuous wave laser is a superior micro-invasive surgery method for patients with Bladder neck contracture,which shows little blood loss,high level safety,convenient operation and infrequent complications.
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Objective To discuss the efficacy of transurethral electro-resection combined with needle electrode treatment for bladder neck contracture after treatments of benign prostatic hyperplasia(BPH).Methods A total of 45 cases of bladder neck contracture that developed after treatments of BPH were treated with transurethral electro-resection combined with needle electrode treatment in our hospital.During the operation,the raised posterior lip of the bladder neck was cut at 6 o’clock point,and then the scar tissues at 3 and 9 o’clock points were resected to expose the bladder detrusor.The scar tissues at 12 o’clock point should be removed as much as possible so that the bladder neck could be repaired easily.Afterwards,the fibrotic ring of the bladder neck was cut through at 5 and 7 o’clock points with a needle electrode,the fat tissues covering the bladder could be exposed.Results After the operation,43 of the cases restored normal urine flow.The other 2 patients could urinate despite of mild dysuria,and the symptom was then improved by oral ?1 antagonist and M agonist.Fifteen patients developed micturition frequency and urgency,and odynuria,and were cured pontaneously in two weeks.No patient showed urinary bleeding,stricture,incontinence,or recto-vesical fistula.Follow-up was available in the patients for 3 to 30 months(mean,15 months),during the period,reexaminations showed a Qmax of 15.5-24.3 ml/s(mean,19.5),and residual urine after urination of 0-35 ml(mean,20).No relapse of bladder neck contracture occurred in this series.Conclusions Transurethral electro-resection combined with needle electrode treatment is effective for patients with bladder neck contracture after treatments of BPH.The rate of relapse is low after the operation.
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The bladder neck contracture is not uncommon in children and adult. The etiology remains controversial despite extensive studies, however it is usually accepted that bladder neck contracture is congenital in children and is due to previous lower urogenital infections in most of adult males. In spite of various modalities of treatment its high recurrence rate has been a perplexing problem. During the period from January 1, 1973 to December 31, 1976, 90 cases of adult male bladder neck contractures were studied clinically. Transurethral vesical neck resection was performed on 15 cases and phenoxybenzamine treatment was taken on 9 cases. The following results were obtained. 1) The age range of the patients in this study was from 17 to 79 years. 27.8% of the cases were between 30 and 39 years old and the most patients of group III were observed beyond 40 years of age. 2) The patients of group III usually has longer history of symptoms than group I and II patients. 55.6% of the cases had the onset of one year to 5 years. 3) Analysis of the 90 cases shows that common urinary symptoms were frequency(70%), diminished and weak stream(66.7%) and tenesmus(44.4%). 4) 88% of the cases was associated with the one or more diseases of chronic prostatitis, posterior urethritis or verumontanitis. 5) The bladder trabeculation was the most common finding(91.1%). In 73.3% of the cases interureteric ridge was elevated. Vesical outlet was narrowed as reversed V shape in almost all cases. 6) In 68.8% of the cases urine findings was normal, Pyuria was observed in 20% and microscopic hematuria in 16.6%. 7) Transurethral vesical neck resection was performed in 15 cases; All preoperative symptoms were relieved in 10 cases, but no improvement was observed in 5 cases. 8) 9 cases were treated with sympatholytic drug, phenoxybenzamine and significant improvement of all obstructive symptoms was obtained after 10 days or 2 weeks of treatment in all cases.
Subject(s)
Adult , Child , Humans , Male , Contracture , Hematuria , Neck , Phenoxybenzamine , Prostatitis , Pyuria , Recurrence , Urethritis , Urinary BladderABSTRACT
Three cases of bladder neck contracture with vesico-ureteral reflux are reported. 2 young patients with symptoms of obstruction had severe bilateral hydronephrosis with vesico-ureteral reflux due to bladder neck contracture. One patient had underwent vesico-ureteroplasty with the procedure of Politano-Leadbetter technique and the another with paquin's technique. The third child had complained persistent pyelonephritis without vesicoureteral reflux. Following ureteral dilatation, the fever lysed within 2 weeks and no residual urine was noted.
Subject(s)
Child , Humans , Contracture , Dilatation , Fever , Hydronephrosis , Neck , Pyelonephritis , Ureter , Urinary Bladder , Vesico-Ureteral RefluxABSTRACT
A clinical observation was made on twenty cases, 18 males and 2 females, haying transurethral resection for the bladder neck obstructions in the Department of Urology, Seoul National University Hospital during the period September, l967 through August 1968. And the following results were Obtained: 1. Diseases necessitating T.U.R. were bladder neck contracture; 10 cases, benign prostatic hyperplasia; 9 cases and adenocarcinoma of the prostate; 1 case. 2. Age distribution ranged from 29 years to 83 years with the average of 59.4 years. 10 cases or 50% were in the age group of 60-79. 3. Dysuria which occurredin 14 cases (70 %) is the most common initial disturbance. The other common manifestations were hesitancy, frequency, acute urinary retention, nocturia and emal1 urinary stream as in order. 4. There was no operative complication in all but in 2 cases of hemorrhage which required multiple transfusions and one case ofurinary retention. 5. Postoperative results 1 to 2 weeks after T.U.R, were excellent' in 13, "fair" or "improved" in 4 "poor" in 3.