450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection in the treatment of bladder neck contracture: a case report / 现代泌尿外科杂志

【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.

Micro-invasive treatment of bladder neck contracture following transurethral resection of prostate / 中华泌尿外科杂志

Objective:To investigated the efficacy and safety of transurethral bladder neck incision and laparoscopic modified bladder neck Y-V plasty in the treatment of bladder neck contracture (BNC)after transurethral resection of prostate (TURP).Methods:The clinical data of 57 patients with BNC after TURP who were treated in the Department of Urology, Sixth People's Hospital, Shanghai Jiaotong University School of Medicine from January 2013 to December 2022 were retrospectively analyzed.And the patients were divided into two groups based on the different surgical approaches. There were 22 cases in the transurethral bladder neck incision group, with an average age of (73.75±7.62) years and the preoperative urinary flow Q max of (3.92±2.73) ml/s. The preoperative International Prostate Symptom Score (IPSS) was (26.92±3.34) points, and the quality of life (QOL) score was (4.83±0.72) points. There were 35 cases in laparoscopic modified bladder neck Y-V plasty group, with an average age of (68.57±9.31) years and the preoperative urinary flow Q max of (2.56±1.27)ml/s. The preoperative IPSS was (27.08±3.06) points, and the QOL score was (5.08±0.84) points. The patients underwent transurethral bladder neck incision: Scar tissue was incised at 3, 9, and 12 o'clock in the bladder neck, and the incision depth reached the external fat of the bladder neck at 3 and 9 o'clock. Patients with significantly elevated bladder neck were treated with plasma electrosurgical resection to remove scar tissue. The patients underwent laparoscopic modified bladder neck Y-V plasty: After proper exposition of the bladder neck, the scar tissue was excised. the anterior bladder wall was incised in an inverted Y-shaped manner, the apex of the V-shaped flap was sutured to the distal urethrotomy to create a widened bladder neck. The postoperative urinary flow Q max, IPSS, and QOL of the two groups were compared. Results:All patients underwent surgeries successfully, with a one-time success rate of 94.3% (33/35) in the laparoscopic modified bladder neck Y-V plasty group, which was higher than the one-time success rate of 68.2% (15/22) in the transurethral bladder neck incision group( P<0.01). There were statistically significant difference in operation time [(31.75±12.81)min vs. (68.57±22.36)min] and postoperative hospital stay [(1.73±0.94)d vs. (5.17±2.12)d] between the transurethral bladder neck incision group and the laparoscopic modified bladder neck Y-V plasty group ( P<0.05). The median follow-up period was 12.6 (7.3, 27.8) months. The IPSS of the transurethral bladder neck incision group and the laparoscopic modified bladder neck Y-V plasty group were (9.92±2.56) points and (7.16±2.21) points, respectively. The QOL was (2.76±1.24) points and (1.31±0.95) points, respectively. The urinary flow Q max at 6 months after operation was (15.13±4.68)ml/s and (19.96±4.17)ml/s, respectively. There was statistical significance( P<0.05). Conclusions:Both laparoscopic modified bladder neck Y-V plasty and transurethral bladder neck incision are safe and effective in the treatment of BNC after TURP, and laparoscopic modified bladder neck Y-V plasty has a better clinical therapeutic effect.

Efficacy and safety of bladder neck resection combined with local steroid injection in the treatment of bladder neck contracture after TURP / 中华泌尿外科杂志

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.

Clinical analysis of modified YV-plasty for the treatment of recurrent bladder neck contracture / 中华泌尿外科杂志

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.

Effect of selectiveα1 adrenergic receptor blocking agent in the treatment of bladder neck contracture caused by refractory urinary tract infection in elder / 中国生化药物杂志

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.

Clinical efficacy of 2 μm continuous wave laser treatment on patients with bladder neck contracture after benign prostatic hyperplasia operation / 中国综合临床

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.

Transurethral Electro-Resection Combined with Needle Electrode Treatment for Bladder Neck Contracture after Treatments of BPH:Report of 45 Cases / 中国微创外科杂志

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.

Clinical Observations on the Bladder Neck Contracture of Adult Males / 대한비뇨기과학회지

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.

Bladder Neck Contracture in 3 Patients / 대한비뇨기과학회지

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.

Clinical Observation on the Bladder Neck Obstruction Treated with Transurethral Resection / 대한비뇨기과학회지

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.