Transurethral incision of the bladder neck in recurrent bladder neck stenosis

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Abstract

BACKGROUND: Transurethral incision of the bladder neck is one of the main methods of correction of bladder neck stenosis that occurred after treatment of patients with benign prostatic hyperplasia. This technique involves endoscopic dissection in the area of the stenosed area without removing scar tissue. Taking into account the emergence of new reconstructive methods of surgical intervention in patients with recurrent bladder neck stenosis the expediency of using transurethral incision of the bladder neck in recurrent cases remains a subject of discussion.

AIM: The aim of the study is to evaluate the effectiveness of the use of transurethral incision of the bladder neck in patients with recurrent bladder neck stenosis.

MATERIALS AND METHODS: The study included 30 patients with a diagnosis of recurrent bladder neck stenosis who were treated in the period from 2012 to 2022. in Clinical Hospital of St. Luke and was performed transurethral incision of the bladder neck using bipolar electrosurgical energy. The diagnosis of bladder neck stenosis was established on the basis of complaints, anamnesis, uroflowmetry with determination of the volume of residual urine, ureteroscopy, retrograde urethrography. Recurrence was recorded when the maximum urination rate below 12 ml/s, there was an episode of acute urinary retention, or the need for additional surgical intervention for bladder outlet obstruction.

RESULTS: All 30 patients underwent transurethral incision of the bladder neck using bipolar electrosurgical energy. The average duration of surgery was 22.9 minutes. The degree of postoperative complications did not exceed grade II according to the Clavien scale. The frequency of de novo stress urinary incontinence was detected only in one patient, which resolved spontaneously within 6 weeks. The maximum urination rate after 3 months was 14.73 ± 3.61 ml/s, while after 6 months there was a significant decrease to 10.91 ± 6.92 ml/s, and after 12 months — to 9.4 ± 7, 65 ml/s. The absence of recurrence in patients after TUI BN during the observation period was noted in 17 (56.67%) patients.

CONCLUSIONS: Transurethral incision of the bladder neck using a bipolar electrode is a safe method for correcting bladder neck stenosis, but in recurrent cases it has limited efficacy. In this regard, in patients with a large number of endoscopic interventions in history, other methods of bladder neck reconstruction should be chosen.

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About the authors

Sergey V. Popov

Clinical Hospital of St. Luke; S.M. Kirov Military Medical Academy

Email: doc.popov@gmail.com
ORCID iD: 0000-0003-2767-7153
SPIN-code: 3830-9539

MD, Doc. Sci. (Med.), urologist, chief physician, professor of the Urology Department

Russian Federation, Saint Petersburg; Saint Petersburg

Igor N. Orlov

Clinical Hospital of St. Luke; North-Western State Medical University named after I.I. Mechnikov

Email: doc.orlov@gmail.com
ORCID iD: 0000-0001-5566-9789
SPIN-code: 2116-4127

Cand Sci. (Med.), urologist, deputy chief physician for medical affairs, assistant professor of the Urology Department

Russian Federation, Saint Petersburg; Saint Petersburg

Aleksey V. Tsoy

Clinical Hospital of St. Luke

Author for correspondence.
Email: alekseytsoy93@gmail.com
ORCID iD: 0000-0001-6169-2539
SPIN-code: 4253-9083

urologist

Russian Federation, Saint Petersburg

Timur M. Topuzov

Clinical Hospital of St. Luke

Email: ttopuzov@gmail.com
ORCID iD: 0000-0002-5040-5546
SPIN-code: 8468-4547

MD, Cand. Sci. (Med.), head of Urological Unit

Russian Federation, Saint Petersburg

Valeriya V. Malik

Saint Petersburg State University

Email: lera.bartyshova@mail.ru
ORCID iD: 0000-0002-1229-6908

clinical resident

Russian Federation, Saint Petersburg

Alexander I. Neymark

Altai State Medical University

Email: neimark.a@mail.ru
ORCID iD: 0000-0002-5741-6408
SPIN-code: 4528-7765
Scopus Author ID: 7102411541

MD, Dr. Sci. (Med.), Professor, head of the Department of Urology and Andrology with a Course of Additional Professional Education

Russian Federation, Barnaul, Altai Region

Boris A. Neymark

Altai State Medical University; Clinical Hospital Russian Railways-Medicine

Email: neimark.b@mail.ru
ORCID iD: 0000-0001-8009-3777
SPIN-code: 7886-8442
Scopus Author ID: 6602800153

MD, Dr. Sci. (Med.), Professor of the Department of Urology and Andrology with a Course of Additional Professional Education, head of the Urological Division

Russian Federation, Barnaul, Altai Region; Barnaul, Altai Region

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2. Fig. 1. Transurethral incision of the bladder neck with a preserved lumen: a — stenotic neck of the bladder before the operation; b, c — incision of the bladder neck with a bipolar needle electrode at 3 o’clock of the conditional dial to paravesical tissue; d — incision of the bladder neck at 9 o’clock of the conditional dial to the paravesical tissue and bleeding vessels

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3. Fig. 2. Transurethral incision of the bladder neck with complete obliteration of the lumen: a, b — bladder puncture with an endoscopic needle through the obliterated bladder neck; с — dissection of the bladder neck along the “guide” string with a cold urethrotomy knife; d — continuation of the dissection of the bladder neck with a bipolar instrument

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4. Fig. 3. Maximum flow rate (Qmax) before and 3, 6 and 12 months after transurethral incision of the bladder neck (n = 30)

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5. Fig. 4. Risk of recurrence of bladder neck stenosis depending on the number of operations in the anamnesis

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