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Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique

PURPOSE: Bladder neck contracture (BNC) is a well-recognized complication following robot-assisted radical prostatectomy (RARP) for treatment of localized prostate cancer with a reported incidence of up to 1.4%. In this series, we report our institutional experience and management results. METHODS:...

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Autores principales: Parihar, Jaspreet Singh, Ha, Yun-Sok, Kim, Isaac Yi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Asian Pacific Prostate Society (APPS) 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970984/
https://www.ncbi.nlm.nih.gov/pubmed/24693529
http://dx.doi.org/10.12954/PI.13034
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author Parihar, Jaspreet Singh
Ha, Yun-Sok
Kim, Isaac Yi
author_facet Parihar, Jaspreet Singh
Ha, Yun-Sok
Kim, Isaac Yi
author_sort Parihar, Jaspreet Singh
collection PubMed
description PURPOSE: Bladder neck contracture (BNC) is a well-recognized complication following robot-assisted radical prostatectomy (RARP) for treatment of localized prostate cancer with a reported incidence of up to 1.4%. In this series, we report our institutional experience and management results. METHODS: A prospectively collected database of patients who underwent RARP by a single surgeon from 2006 to 2012 was reviewed. Watertight bladder neck to urethral anastomosis was performed over 18-French foley catheter. BNC was diagnosed by flexible cystoscopy in patients who developed symptoms of bladder outlet obstruction. Subsequently, these patients underwent cold knife bladder neck incisions. Patients then followed a strict self regimen of clean intermittent catheterization (CIC). We identify the patient demographics, incidence of BNC, associated risk factors and success of subsequent management. RESULTS: Total of 930 patients who underwent RARP for localized prostate cancer was identified. BNC was identified in 15 patients, 1.6% incidence. Mean patient age and preoperative prostate-specific antigen was 58.8 years old and 7.83 ng/mL (range, 2.5–14.55 ng/mL) respectively. Mean estimated blood loss was 361±193 mL (range, 50–650 mL). Follow-up was mean of 23.4 months. Average time to BNC diagnosis was 5.5 months. In three patients, a foreign body was identified at bladder neck. On multivariate analysis, estimated blood loss was significantly associated with development of BNC. All patients underwent cystoscopy and bladder neck incision with a 3-month CIC regimen. Out of 15 index patients, none had a BNC recurrence over the follow-up period. CONCLUSIONS: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen.
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spelling pubmed-39709842014-04-01 Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique Parihar, Jaspreet Singh Ha, Yun-Sok Kim, Isaac Yi Prostate Int Original Articles PURPOSE: Bladder neck contracture (BNC) is a well-recognized complication following robot-assisted radical prostatectomy (RARP) for treatment of localized prostate cancer with a reported incidence of up to 1.4%. In this series, we report our institutional experience and management results. METHODS: A prospectively collected database of patients who underwent RARP by a single surgeon from 2006 to 2012 was reviewed. Watertight bladder neck to urethral anastomosis was performed over 18-French foley catheter. BNC was diagnosed by flexible cystoscopy in patients who developed symptoms of bladder outlet obstruction. Subsequently, these patients underwent cold knife bladder neck incisions. Patients then followed a strict self regimen of clean intermittent catheterization (CIC). We identify the patient demographics, incidence of BNC, associated risk factors and success of subsequent management. RESULTS: Total of 930 patients who underwent RARP for localized prostate cancer was identified. BNC was identified in 15 patients, 1.6% incidence. Mean patient age and preoperative prostate-specific antigen was 58.8 years old and 7.83 ng/mL (range, 2.5–14.55 ng/mL) respectively. Mean estimated blood loss was 361±193 mL (range, 50–650 mL). Follow-up was mean of 23.4 months. Average time to BNC diagnosis was 5.5 months. In three patients, a foreign body was identified at bladder neck. On multivariate analysis, estimated blood loss was significantly associated with development of BNC. All patients underwent cystoscopy and bladder neck incision with a 3-month CIC regimen. Out of 15 index patients, none had a BNC recurrence over the follow-up period. CONCLUSIONS: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen. Asian Pacific Prostate Society (APPS) 2014-03 2014-03-30 /pmc/articles/PMC3970984/ /pubmed/24693529 http://dx.doi.org/10.12954/PI.13034 Text en Copyright © 2014 Asian Pacific Prostate Society (APPS) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Parihar, Jaspreet Singh
Ha, Yun-Sok
Kim, Isaac Yi
Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
title Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
title_full Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
title_fullStr Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
title_full_unstemmed Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
title_short Bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
title_sort bladder neck contracture–incidence and management following contemporary robot assisted radical prostatectomy technique
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970984/
https://www.ncbi.nlm.nih.gov/pubmed/24693529
http://dx.doi.org/10.12954/PI.13034
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