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

2016 ◽  
Vol 10 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Shieh L. Bang ◽  
Sachin Yallappa ◽  
Fatima Dalal ◽  
Yahia Z. Almallah
Keyword(s):  
Bladder Neck ◽  
Urinary Continence ◽  
Male Sling ◽  
Bladder Neck Contracture ◽  
Initial Management ◽  
Flexible Cystoscopy ◽  
Bladder Neck Incision ◽  
The Mean ◽  
Sling Placement

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.

scholarly journals Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Masaru Morita ◽  
Takeshi Matsuura
Keyword(s):  
Prostate Cancer ◽  
Bladder Neck ◽  
Peripheral Zone ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Bladder Neck Contracture ◽  
Psa Failure ◽  
The Mean

Background. We analyzed radical TUR-PCa against localized prostate cancer.Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients’ age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients’ age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL.Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months’ follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction.Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

Long-term Impacts of Concurrent Posterior Urethral Valve Ablation and Bladder Neck Incision on Urinary Continence and Ejaculation

Urology ◽  
2017 ◽  
Vol 99 ◽  
pp. 278-280 ◽  
Author(s):  
Sorena Keihani ◽  
Abdol-Mohammad Kajbafzadeh ◽  
Seyedeh Maryam Kameli ◽  
Reza Abbasioun
Keyword(s):  
Bladder Neck ◽  
Posterior Urethral Valve ◽  
Urinary Continence ◽  
Bladder Neck Incision ◽  
Urethral Valve

Target focal therapy in early prostate cancer: Initial single institution results

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15574-15574 ◽  
Author(s):  
A. Barqawi ◽  
J. Lugg ◽  
E. D. Crawford
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Focal Therapy ◽  
Urinary Continence ◽  
Minimal Impact ◽  
Alternative Option ◽  
Early Results ◽  
The Mean ◽  
Mapping Biopsy

15574 Background: Currently the potential for over- and under-treatment using radical and watchful waiting options respectively constitutes a challenge in the management of patients with early organ-confined prostate cancer. Target focal therapy (TFT) is emerging as an intermediary alternative option for such men. The goal is to provide ablative treatment with minimal impact on morbidity. Methods: As part of an IRB approved study protocol a total of 24 patients initially underwent a 3 dimensional transperineal mapping biopsy under TRUS guidance to confirm the extent of tumor burden and localize the cancer foci within the prostate. Only 12 men qualified to undergo target focal cryotherapy. The remaining patients did not qualify due to upgrading or downgrading of their stage and opted for other treatment options. Follow- up consisted of serial PSA measurements at 3 months interval, disease specific QOL questionnaires, IPSS, and SHIM scores. Results: The mean age was 62.4 years. The mean (SD) prostate size at the time of mapping biopsy was 39 ±14.8g. After mapping biopsy all patients reported time limited hematuria and 2 patients developed urinary retention and were managed successfully with Foley’s catheter for 5 days. Mean PSA before treatment was 5.2 ± 4.1 ng/dl. 10/12 patients had Gleason score (GS) of 3+3, the remaining 2 patients had GS of 3+4. At 3 months follow-up. A median drop of PSA of 1.9 (0, 9.5) ng/dl. All patients reported full urinary continence post operatively. IPSS median drop of 0 (2, -16). Sexual health as assessed by SHIM score showed a median drop of 6 (1, -15) points. In general 4 patients reported a significant change in sexual performance. 2 of which opted for PDE inhibitor with successful regaining of erection at 6 months follow-up. Overall EPIC QOL scores showed no change in rectal, urinary and hormonal components. Sexual component registered a drop of 5 points. Conclusions: The current initial early results appear to be encouraging for future implementation of TFT on select patients with organ confined early stage cancer. Future larger randomized studies are needed to better understand the value of this alternative option in the management of prostate cancer. No significant financial relationships to disclose.

Transurethral Resection of the Prostate in Recurrent Acute Bacterial Prostatitis

2014 ◽  
Vol 94 (4) ◽  
pp. 442-444 ◽  
Author(s):  
Karel Decaestecker ◽  
Willem Oosterlinck
Keyword(s):  
Side Effects ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Infected Tissue ◽  
Bladder Neck Contracture ◽  
Bacterial Prostatitis ◽  
Acute Bacterial Prostatitis ◽  
Disease Free

Objective: To explore the outcome of transurethral resection of the prostate (TURP) in the treatment of refractory recurrent acute bacterial prostatitis. Patients and Methods: From 2004 to 2013, 23 TURP for this indication were performed in 21 patients; two patients underwent it twice. The files of these patients were retrospectively analysed for outcome and side effects. TURP intended to remove as much infected tissue as possible under appropriate antibiotherapy. Results: Twelve patients became free of symptoms during a follow-up of 3-108 months (median 44), two others became disease-free after one and two postoperative attacks, respectively; eight were not cured and had rapid recurrences; three patients had follow-up of a few weeks only. Two failures developed orchiepididymitis shortly after the procedure and one a year later. No incontinence or bladder neck contracture was noted. Conclusion: TURP is an acceptable procedure in the treatment of refractory recurrent bacterial prostatitis. It could cure about two thirds of patients.

scholarly journals Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

2019 ◽  
Vol 14 (4) ◽  
pp. 621-625 ◽  
Author(s):  
A. Nathan ◽  
G. Mazzon ◽  
N. Pavan ◽  
R. De Groote ◽  
A. Sridhar ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Urinary Diversion ◽  
Bladder Neck ◽  
Stent Insertion ◽  
Intermittent Catheterisation ◽  
Neck Reconstruction ◽  
Clean Intermittent Catheterisation ◽  
Bladder Neck Reconstruction ◽  
The Mean

Abstract The incidence of vesicourethral anastomotic stenosis (VUAS) post radical prostatectomy varies from 1 to 26%. Current treatment can be challenging and includes a variety of different procedures. These range from endoscopic dilations to bladder neck reconstruction to urinary diversion. We investigated a 2-stage endoscopic treatment, using the thermo-expandable Memokath®045 bladder neck stent to manage patients with VUAS post radical prostatectomy. We retrospectively reviewed 30 patients, between 2013 and 2017, who underwent a Memokath®045 stent insertion following failed primary treatment (dilation and clean intermittent catheterisation) for VUAS. The mean interval time between prostatectomy and Memokath®045 stent insertion was 13 months. The mean follow-up time was 3.6 years with all patients having a minimum of 12-month follow-up. All patients had two previous attempts at endoscopic dilatation with or without incision and a trial of clean intermittent catheterisation. During stage 1, the anastomotic stricture is dilated/incised to diameter of 30 Fr, the stricture length is measured, and a catheter is left in situ. One to 2 weeks later, post haemostasis and healing, an appropriately sized Memokath®045 stent is inserted. The stent is then removed 1-year post-op. Our series of patients had a median age of 62 (54–72). Most patients (26) had a robot-assisted radical prostatectomy (RARP) or salvage procedure. Results showed improvement in IPSS scores, IPSS quality of life scores, Qmax and PVR after the Memokath®045 stent was removed compared to pre-operation. With a minimum of 12 months post stent removal, 93% of patients were fully continent, whilst 7% of patients were socially continent. 2 (7%) patients had their stents removed and not replaced due to re-stricturing and stone formation. However, no urinary tract infections, stricture recurrence or urinary retention was observed in the rest of the cohort (93%). Overall, the Memokath®045 stent was successful in treating 93% of our patients with VUAS. Our series had minimal complications that were managed with conservative measures and in three patients’ re-operation was needed. In conclusion, the Memokath®045 stent is a minimally invasive technique with faster recovery time compared to other techniques such as bladder neck reconstruction or urinary diversion. Additionally, it provides superior patency results compared to other techniques such as bladder neck incision and injection of Mitomycin C. Therefore, this management option should be considered in the management of VUAS.

scholarly journals Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings

2013 ◽  
Vol 5 (2) ◽  
pp. 107
Author(s):  
Amr Al-Najar ◽  
Sascha Kaufmann ◽  
Soenke Boy ◽  
Carsten Maik Naumann ◽  
Peter-Klaus Jünemann ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Artificial Urinary Sphincter ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Male Sling ◽  
Pelvic Irradiation ◽  
Urinary Sphincter ◽  
Sling Placement

Objective: Our objective was to establish the feasibility of combining2 minimally invasive procedures in patients with failed primarytreatment (male sling) in post-prostatectomy incontinence(PPI) patients.Methods: From January 2007 to July 2008, 40 men with PPI wereimplanted with a suburethral tape (2 patients with Seratim, 3 withI-Stop and 35 with Advance). The median preoperative pad countwas 4 (range 2-10). Prior to sling placement, 6 patients had undergoneProACT implantation. Of these, 4 patients required explantationdue to balloon migration and 2 patients had their balloonskept in situ, with the balloons deflated.Results: Twenty-five patients were socially continent at this time.Fifteen patients (37.5%) did not improve or their improvementwas not significant. These patients had a preoperative pad countbetween 7 and 10. Two of these patients had prostate adjustablecontinence therapy (ProACT) systems still in place. By graduallyfilling the balloons to 3 mL, both of these patients achieved completecontinence, which was maintained at a mean follow-up of8.5 months. Three patients with prior pelvic irradiation receivedan artificial urinary sphincter and achieved continence at meanfollow-up of 8.3 months. The remaining 10 patients received aProACT system in addition to the already implanted sling. Afterappropriate healing and filling of the balloons (average balloonvolume 5 mL), all 10 patients reached complete continence; theywere pad-free at a mean follow-up of 6 months (range 3-9).Conclusions: The combination of ProACT and a suburethral tapewas demonstrated to be a possible treatment option in recurrentor persistent PPI.Objectif : Notre objectif était d’établir la faisabilité d’une associationde 2 interventions minimalement invasives chez des patients ayantsubi un échec thérapeutique primaire (bandelettes sous-urétrales)chez des patients atteints d’incontinence post- prostatectomie.Méthodologie : De janvier 2007 à juillet 2008, on a placé une bandelettesous-urétrale chez 40 hommes atteints d’incontinence postprostatectomie(2 patients ont reçu le dispositif de marque Seratim,3 patients, de marque I-Stop et 35, de marque Advance). Le nombremédian de protections absorbantes avant l’opération était de 4 (2 à10). Avant la mise en place de la bandelette, 6 patients avaient subiune implantation d’un système ProACT. De ce nombre, 4 patientsont dû se faire retirer les ballonnets en raison de leur déplacement;chez 2 patients, les ballonnets sont restés en place mais se sontdégonflés.Résultats : Vingt-cinq patients présentaient une continence socialeà ce moment. Quinze patients (37,5 %) n’ont présenté aucuneamélioration, ou une amélioration non significative. Ces patientsutilisaient de 7 à 10 protections absorbantes avant l’opération. Deuxde ces patients étaient toujours porteurs d’un système ProACT. Enremplissant graduellement les ballonnets de 3 mL, ces deux patientsont atteint une continence totale, maintenue après un suivi moyende 8,5 mois. Trois patients ayant reçu antérieurement un traitementpelvien par rayonnement ont reçu un sphincter urinaire artificielet ont atteint la continence après un suivi moyen de 8,3 mois.Chez les 10 derniers patients, on a implanté un système ProACTen plus de la bandelette déjà en place. Après un temps suffisant deguérison et le remplissage des ballonnets (volume moyen : 5 mL),les 10 patients ont atteint une continence complète. Ils n’avaientplus besoin de protection absorbante après un suivi moyen de6 mois (entre 3 et 9 mois).Conclusions : L’association d’un système ProACT et d’une bandelettesous-urétrale s’est révélée une option thérapeutique possibleen présence d’incontinence post-prostatectomie récurrenteou persistante.

scholarly journals The impact of bladder neck sparing on urinary continence during laparoscopic radical prostatectomy; Results from a high volume centre

2017 ◽  
Vol 89 (3) ◽  
pp. 186 ◽  
Author(s):  
Ali Serdar Gozen ◽  
Yigit Akin ◽  
Mutlu Ates ◽  
Marcel Fiedler ◽  
Jens Rassweiler
Keyword(s):  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Multivariate Analyses ◽  
Laparoscopic Radical Prostatectomy ◽  
Urinary Continence ◽  
Neck Reconstruction ◽  
Bladder Neck Reconstruction ◽  
Group 3 ◽  
The Impact

Objective: To evaluate the effects of bladder neck reconstruction techniques on early continence after laparoscopic radical prostatectomy (LRP). Materials and methods: This non-randomized retrospective study analyzed prospectively collected data concerning LRP. In total, 3107 patients underwent LRP between March 1999 and December 2016. Exclusion criteria were preoperative urinary incontinence, previous history of external beam radiotherapy, co-morbities which may affect urinary continence such as diabetes mellitus and/or neurogenic disorders, irregular followup, and follow-up shorter than 24 months. All patients were divided into one of three groups, posterior reconstruction being performed in Group 1 (n = 112), anterior reconstruction in Group 2 (n = 762), and bladder neck sparing (BNS) in Group 3 (n = 987). Demographic and pre-, peri-, and postoperative data were collected. Multivariate analyses were performed to determine factors affecting early continence after LRP. Results: 1861 patients were enrolled in the study. The mean follow-up period was 48.12 ± 29.8 months, and subjects’ mean age was 63.6 ± 6.2 years. There was no significant difference among the groups in terms of demographic or preoperative data. Postoperative data, including oncological outcomes, were similar among the groups. The level of early continence was higher in Group 3 than in the other groups (p < 0.001). Multivariate analyses identified BNS and age as parameters significantly affecting early continence levels after LRP (p < 0.001 and p < 0.001, respectively). Bladder neck reconstruction provided less earlier continence than BNS.

Sign in / Sign up

Export Citation Format

Share Document