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Management Strategies for Post-Prostatectomy Bladder Neck Contractures

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)
  • Published:
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Abstract

Patients who develop bladder neck contracture (BNC) after surgical treatment for prostate cancer often present with progressive lower urinary tract symptoms. Multiple risk factors contribute to BNC development including patient-related factors and technical considerations at the time of surgery. Initial management begins with endoscopic therapies, including dilation, transurethral incision (TUIBNC), and injection of adjunctive agents. When BNC remains refractory to these therapies, surgical reconstruction of the vesicourethral anastomosis or urinary diversion can be considered in select cases. This review presents an outline of the management of BNC after radical prostatectomy (RP), highlighting the recent literature related to the subject.

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References

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

  1. Erickson BA, McAninch JW, Eisenberg ML, Washington SL, Breyer BN. Management for prostate cancer treatment related posterior urethral and bladder neck stenosis with stents. J Urol. 2011;185:198–203.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Parihar JS, Ha YS, Kim IY. Bladder neck contracture-incidence and management following contemporary robot assisted radical prostatectomy technique. Pros Int. 2014;2:12–8.

    Article  Google Scholar 

  3. Cho HJ, Jung TY, Kim DY, Byun SS, Kwon DD, Oh TH, et al. Prevalence and risk factors of bladder neck contracture after radical prostatectomy. Korean J Urol. 2013;54:297–302.

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Herschorn S, Elliott S, Coburn M, Wessells H, Zinman L. SIU/ICUD consultation on urethral strictures: posterior urethral stenosis after treatment of prostate cancer. Urology. 2014;83:S59–70. This article provides an excellent, comprehensive review of the work-up and management of bladder neck contractures as compiled by some of the leading authorities in the field.

    Article  PubMed  Google Scholar 

  6. 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 

  7. Mucciardi G, Gali A, Inferrera A, Di Benedetto A, Macchione L, Mucciardi M, et al. Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results. Int Urol Nephrol. 2013;45:721–6.

    Article  PubMed  Google Scholar 

  8. 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 

  9. Izadpanahi MH, Honarmand R, Khorrami MH, Najarzadegan MR, Sichani MM, Alizadeh F. A comparison of bladder neck preservation and bladder neck reconstruction for urinary incontinence after radical retro pubic prostatectomy. J Res Med Sci. 2014;19:1140–4.

    PubMed Central  PubMed  Google Scholar 

  10. Cormio L, Massenio P, Lucarelli G, Di Fino G, Selvaggio O, Micali S, et al. Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy. BMC Urol. 2014;14:21.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Shin YS, Doo AR, Cha JS, Kim MK, Jeong YB, Kim HJ. Floating Hem-o-Lok clips in the bladder without stone formation after robot-assisted laparoscopic radical prostatectomy. Korean J Urol. 2012;53:60–2.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Ganpule A, Dhawan DR, Desai MR. Hem-o-lok clip eroding into the urethra following laparoscopic radical prostatectomy: a case report and review of literature. Indian J Urol. 2010;26:580–1.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Yi JS, Kwak C, Kim HH, Ku JH. Surgical clip-related complications after radical prostatectomy. Korean J Urol. 2010;51:683–7.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Sowerby RJ, Gani J, Yim H, Radomski SB, Catton C. Long-term complications in men who have early or late radiotherapy after radical prostatectomy. Can Urol Assoc J = J de l’Assoc des urologues du Canada. 2014;8:253–8.

    Google Scholar 

  15. King T, Almallah YZ. Post-radical-prostatectomy urinary incontinence: the management of concomitant bladder neck contracture. Adv Urol. 2012;2012:295798.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Brede C, Angermeier K, Wood H. Continence outcomes after treatment of recalcitrant postprostatectomy bladder neck contracture and review of the literature. Urology. 2014;83:648–52.

    Article  PubMed  Google Scholar 

  17. 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;82:1430–5.

    Article  PubMed  Google Scholar 

  18. 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. J Urol. 2014;191:143–7.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Anger J. Management of recalcitrant bladder neck contracture after radical prostatectomy for prostate cancer. Uro Lume Stent J Urol. 2011;185:391–2.

    Article  Google Scholar 

  20. Kuyumcuoglu U, Eryildirim B, Tarhan F, Faydaci G, Ozgul A, Erbay E. Antegrade endourethroplasty with free skin graft for recurrent vesicourethral anastomotic strictures after radical prostatectomy. J Endourol. 2010;24:63–7.

    Article  PubMed  Google Scholar 

  21. 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 

  22. Vanni AJ, Zinman LN, Buckley JC. Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures. J Urol. 2011;186:156–60.

    Article  CAS  PubMed  Google Scholar 

  23. Redshaw JD, Broghammer JA, Smith 3rd TG, Voelzke BB, Erickson BA, McClung CD, et al. Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS study group. J Urol. 2015;193:587–92. This is recent multi-institutional review of MMC injection following TUIBNC showed an overall success rate of 75% (41/55) with a 7% rate of serious adverse events. This confirms, yet somewhat tempers, the initial enthusiasm associated with using adjunctive antifibrotic agents in this patient population.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Cox A, Herschorn S. Management of the incontinent patient with a sphincteric stricture following radical prostatectomy. Curr Opin Urol. 2014;24:578–85.

    Article  PubMed  Google Scholar 

  25. Nikolavsky D, Blakely SA, Hadley DA, Knoll P, Windsperger AP, Terlecki RP, et al. Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy. Int Urol Nephrol. 2014;46:2147–52. This article reviews surgical revision of the vesicourethral anastomosis providing a description of a single surgeon’s experience over an eight year period. The article describes an excellent long-term patency rate in experienced hands but tempers this success with a 25% continence rate, highlighting the likely need for a multi-procedure approach to these challenging cases.

    Article  PubMed  Google Scholar 

  26. Simonato A, Ennas M, Benelli A, Gregori A, Oneto F, Daglio E, et al. Comparison between two different two-stage transperineal approaches to treat urethral strictures or bladder neck contracture associated with severe urinary incontinence that occurred after pelvic surgery: report of our experience. Adv Urol. 2012;2012:481943.

    CAS  PubMed Central  PubMed  Google Scholar 

  27. Reiss CP, Pfalzgraf D, Kluth LA, Soave A, Fisch M, Dahlem R. Transperineal reanastomosis for the treatment for highly recurrent anastomotic strictures as a last option before urinary diversion. World J Urol. 2014;32:1185–90.

    Article  PubMed  Google Scholar 

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Robert Caleb Kovell and Ryan Patrick Terlecki each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Robert Caleb Kovell.

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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

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Kovell, R.C., Terlecki, R.P. Management Strategies for Post-Prostatectomy Bladder Neck Contractures. Curr Urol Rep 16, 65 (2015). https://doi.org/10.1007/s11934-015-0536-4

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  • DOI: https://doi.org/10.1007/s11934-015-0536-4

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