Bipolar plasma vaporization in secondary bladder neck sclerosis – initial experience with a new technique

Introduction: Secondary bladder neck sclerosis (BNS) represents one of the most common long-term complications after prostate surgical treatment. In this retrospective study, we aimed to evaluate our initial experience concerning the bipolar plasma vaporization (BPV) performed in patients with secondary BNS and to assess the efficiency, safety and short-term postoperative results of this approach. Materials & Methods: Between May 2009 and May 2010, a total of 30 male patients with BNS underwent BPV and were followed for a period of 6 months. BNS was secondary to monopolar transurethral resection of prostate (TURP) in 19 cases, to open surgery for BPH (open prostatectomy) in 8 cases and to radical prostatectomy for prostate cancer in 3 cases. The follow-up protocol included the International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Qmax) and post-voiding residual urinary volume (RV) evaluated at 1, 3 and 6 months after surgery. Results: BPV was successfully performed in all cases. All patients were able to void spontaneously and were continent after catheter removal. The mean operating time was 9 minutes, the mean catheterization period was 18 hours and the mean hospital stay was 24 hours. Preoperatively and at 1, 3 and 6 months after surgery, the mean values for Qmax and RV were 7.2 ml/s and 110 ml, 23.9 ml/s and 20 ml, 23.8 ml/s and 28 ml, and 23.4 ml/s and 26 ml, respectively. Before surgery and at 1, 3 and 6 months, the IPSS and QoL scores were 22.6 and 4.1, 3.4 and 1.2, 3.6 and 1.4, and 3.7 and 1.4, respectively. Conclusions: BPV represents a valuable endoscopic treatment alternative for secondary BNS with good efficacy, reduced morbidity, fast postoperative recovery and satisfactory follow-up parameters. Abbreviations BNS – bladder neck sclerosis, BPV – bipolar plasma vaporization, TURP – transurethral resection of the prostate, IPSS – International Prostate Symptom Score, QoL – quality of life score, Qmax – maximum flow rate, RV – post-voiding residual urinary volume