scholarly journals A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach

2021 ◽  
Vol 8 (7) ◽  
pp. 87
Author(s):  
Michele Serpilli ◽  
Gianluca Zitti ◽  
Marco Dellabella ◽  
Daniele Castellani ◽  
Elvira Maranesi ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Bladder Neck ◽  
Urethral Sphincter ◽  
Preliminary Validation ◽  
Bladder Neck Incision ◽  
Urinary Tract Symptoms ◽  
Radial Thickness ◽  
Bladder Neck Obstruction ◽  
Primary Bladder ◽  
Primary Bladder Neck Obstruction

A new surgical procedure for the treatment of primary bladder neck obstruction with maintenance of anterograde ejaculation is proposed. In place of monolateral or bilateral bladder neck incision, associated with a loss of ejaculation rate of up to 30%, the new surgical procedure consists of laser drilling the bladder neck with a number of holes and without muscle fiber disruption. The effect of this novel procedure has been studied numerically, with a simplified two-dimensional numerical model of the internal urethral sphincter, varying the position and the number of holes in the fibrotic region of the urethral tissue. Results show an improvement of the urethral sphincter opening by increasing the number of holes, ranging from about 6% to 16% of recovery. Moreover, a non-aligned position of holes positively influences the opening recovery. The concentrations of maximum principal strain and stress have been registered in the proximity of the interface between the physiologic and diseased sphincter, and in those regions where the radial thickness is significantly thinner. The effects on the first five patients have been included in the study, showing improvement in micturition, lower urinary tract symptoms, sustained ejaculatory function, and quality of life.

Transurethral bladder neck incision in women with primary bladder neck obstruction

2014 ◽  
Vol 126 (7-8) ◽  
pp. 217-222 ◽  
Author(s):  
Dean Markić ◽  
Anton Maričić ◽  
Romano Oguić ◽  
Josip Španjol ◽  
Dražen Rahelić ◽  
...  
Keyword(s):  
Bladder Neck ◽  
Bladder Neck Incision ◽  
Bladder Neck Obstruction ◽  
Primary Bladder ◽  
Primary Bladder Neck Obstruction

scholarly journals Use of transvaginal ultrasound in females with primary bladder neck obstruction. A preliminary study

2015 ◽  
Vol 87 (2) ◽  
pp. 158 ◽  
Author(s):  
Vikiela Galica ◽  
Elona Toska ◽  
Pietro Saldutto ◽  
Giuseppe Paradiso Galatioto ◽  
Carlo Vicentini
Keyword(s):  
Bladder Neck ◽  
Transvaginal Ultrasound ◽  
Outlet Obstruction ◽  
Pelvic Organ ◽  
Vaginal Mucosa ◽  
Urinary Tract Symptoms ◽  
Before And After ◽  
Bladder Neck Obstruction ◽  
Primary Bladder ◽  
Primary Bladder Neck Obstruction

Introduction and aim: The video-urodynamics study is the principal exam to establish a possible primary bladder neck obstruction (PBNO) condition. While trans-rectal ultrasonography plays an important role in the evaluation of the low urinary tract symptoms (LUTS) and the severity of bladder outlet obstruction (BOO) in men, the use of the transvaginal ultrasound (TVUS) in women with symptoms suggesting BOO remains unclear. We tried to check the utility of the TVUS in women with PBNO condition. Material and methods: We selected female patients which presented BOO without pelvic organ prolapse (POP). According to the data of the video-urodynamic exam we selected the patients with the suspicion of PBNO. A TVUS in basal and during micturition was performed before and after surgery. Results: TVUS showed a closed bladder neck bladder in basal condition and during micturition similarly to the fluoroscopic image during video-urodynamics. The mean distance from bladder neck to the vaginal mucosa resulted 1.3 cm in this patients. Conclusions: TVUS results worthy in the evaluation of patients with PBNO before and after surgery.

scholarly journals Patients presenting with lower urinary tract symptoms who most deserve to be investigated for primary bladder neck obstruction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nicolò Schifano ◽  
Paolo Capogrosso ◽  
Rayan Matloob ◽  
Luca Boeri ◽  
Luigi Candela ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Bladder Neck ◽  
Lower Urinary Tract ◽  
Prostate Volume ◽  
Urinary Tract Symptoms ◽  
Bladder Neck Obstruction ◽  
Primary Bladder ◽  
Primary Bladder Neck Obstruction ◽  
Rule Out ◽  
Lower Urinary

AbstractWe aimed to investigate clinical features potentially useful in primary bladder neck obstruction (PBNO) diagnosis in men presenting with lower urinary tract symptoms (LUTS). Data from 1229 men presenting for LUTS as their primary complaint at a single centre were retrospectively analysed. All patients underwent a comprehensive medical and physical assessment, and completed the International Prostate Symptoms Score. All patients were investigated with uroflowmetry, and trans-rectal ultrasound imaging to define prostate volume. Urodynamic evaluation was performed when the diagnosis of benign prostatic enlargement was not confirmed and the patient presented a significant chance of detrusor overactivity or underactivity. As per our internal protocol, patients < 60 years old with bothersome LUTS and > 60 years with a prostate volume (PV) < 40 mL were also investigated with urethrocystoscopy to rule out urethral stricture. Logistic regression analysis tested clinical predictors of possible PBNO. Of 1229 patients, 136 (11%) featured a clinical profile which was consistent with PBNO. Overall, these patients were younger (p < 0.0001), had lower BMI (p < 0.0001), less comorbidities (p = 0.004) and lower PSA values (p < 0.0001), but worse IPSS scores (p = 0.01) and lower PV values (p < 0.0001) compared to patients with other-aetiology LUTS. At multivariable analysis, younger age (OR 0.90; p = 0.003) and higher IPSS scores (OR 1.12; p = 0.01) were more likely to be associated with this subset of patients, after accounting for other clinical variables. One out of ten young/middle-aged men presenting for LUTS may be affected from PBNO. Younger patients with more severe LUTS systematically deserve an extensive assessment to rule out PBNO, thus including urethrocystoscopy and urodynamics with voiding-cysto-urethrogram.

Sign in / Sign up

Export Citation Format

Share Document