Assessing Predictors of Failure After Bladder Neck Incision in Patients Who Developed Bladder Neck Stenosis Following Transurethral Surgery for Benign Prostatic Enlargement.

Abstract

Introduction: Bladder neck stenosis (BNS) is a known complication following surgery for benign prostatic enlargement (BPE). While endoscopic bladder neck incision (BNI) is considered a viable treatment option, factors leading to success or failure remain not clearly elucidated.

Methods: Patients receiving BNI for BNS after BPE surgery were included. International Prostate Symptoms Score (IPSS) was assessed 3 months after BNI. Failure after treatment was defined as IPSS between 8 and 35 points (pts). Logistic regression analyses tested association between BNI failure and predicting factors such as Charlson Comorbidity Index (CCI), time from BPE surgery to onset of BNS symptoms (< 6 vs. ≥ 6 months), prostate volume and BPE surgery technique (holmium [ho] laser enucleation of the prostate [HoLEP] vs. transurethral resection of the prostate [TURP]).

Results: Overall, 110 patients underwent BNI. The majority (91.8%) received ho-laser BNI. Three months after BNI, 64.0%, 30.7% and 5.3% patients reported mild (0-7 pts), moderate (8-19 pts), and severe (20-35 pts) symptoms according to IPSS, respectively. A time < 6 months from BPE surgery to the onset of BNS symptoms (OR: 3.87; 95%CI:1.25-13.00; p = 0.02) and prostate volume < 50 g at BPE surgery (OR: 3.47; 95%CI:1.14-11.59; p = 0.03) were statistically significantly associated with BNI failure.

Conclusions: BNI for BNS following BPE surgery is associated with satisfactory outcomes, not influenced by comorbidities and technique for BPE surgery. Short time interval between BPE surgery and onset of BNS symptoms, as well as small prostate volume at BPE surgery seem to increase risk of BNI failure.