Risk factors for the postoperative bladder neck contracture in patients with small-volume prostatic hyperplasia

Can bladder neck thickness on magnetic resonance imaging (MRI) predict early outcomes after anatomic enucleation of the prostate (AEEP) in benign prostatic hyperplasia patients with small-volume prostate?

AIM

We aimed to evaluate whether preoperative bladder neck thickness (BNT) measured by magnetic resonance imaging (MRI) can guide surgical decisions in benign prostatic hyperplasia (BPH) and primary bladder neck obstruction (PBNO) patients with a small volume (≤30 mL).

MATERIALS AND METHODS

The clinical data of 403 patients were retrospectively collected. The Kappa consistency test was used to compare subjective (IPSS-voiding) and objective (Qmax) postoperative outcomes. Multivariable logistic regression identified predictors of the consistency between postoperative objective and subjective evaluations. The receiver operating characteristic (ROC) curve was utilised to identify the optimal preoperative BNT (preop-BNT) cut-off value for predicting residual obstruction.

RESULTS

The Kappa consistency test revealed a significant difference between IPSS-voiding and Qmax improvements (P < 0.001). Multivariable logistic regression identified intravesical prostatic protrusion (IPP), prostate urethral angle (PUA), and preop-BNT as independent factors influencing postoperative outcome consistency. Among 51 PBNO patients confirmed by prostate MRI and urodynamic examination to have residual postoperative obstruction, multivariable logistic regression analysis showed that preop-BNT was an independent risk factor and PUA was an independent protective factor. ROC analysis determined the optimal preop-BNT cut-off value to be 7.50 mm for predicting residual obstruction.

CONCLUSION

PBNO results in a significant difference between postoperative objective evaluation and subjective evaluation improvement in many of these BPH patients with small-volume prostate. Preop-BNT is a valuable indicator for guiding surgical decisions in these patients. Measuring BNT can help determine whether to preserve or incise the bladder neck during anatomic enucleation of the prostate (AEEP), leading to better postoperative outcomes.

Beyond size: A comprehensive overview of small-volume benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most frequently diagnosed benign disorders that cause dysuria in middle-aged and elderly men. Some patients with BPH have relatively small prostates (referred to as small-volume BPH) but still experience the lower urinary tract infection. Medication treatment is typically not successful in these patients. In addition, their pathophysiologic pathways deviate from those previously observed. Furthermore, as there is no accepted protocol for the diagnosis and treatment of small-volume BPH, patients can experience great difficulties in managing surgical complications such as bladder neck contracture. Thus, we reviewed the features of small-volume prostates, preoperative assessment, surgical technique, and management of complications.

Analysis of risk factors for bladder neck contracture after transurethral endoscopic surgery for benign prostatic hyperplasia

OBJECTIVE

To investigate the risk factors of bladder neck contracture (BNC) after transurethral endoscopic surgery for benign prostatic hyperplasia (BPH), and to provide a reference basis for the clinic.

METHODS

Clinical data of patients who underwent transurethral endoscopic surgery in our hospital from December 2019 to May 2023 were retrospectively collected. The incidence and risk factors of BNC after transurethral endoscopic surgery were analyzed by multivariate logistic regression analysis.

RESULTS

A total of 420 cases were included in this study, of which 246 were treated with bipolar transurethral resection of the prostate (bTURP) and 174 with green light laser vaporization of the prostate (GL-PVP), and there was no statistically significant difference in the incidence of BNC when comparing these two types of operations. A total of 18 patients developed BNC after surgery, and the overall incidence of BNC was 4.29%. Multivariate logistic regression analysis showed that smaller preoperative prostate volume (p = 0.042), smoking history (p = 0.009), positive preoperative urine culture (p = 0.001), and prolonged postoperative catheterization days (p = 0.003) were independent risk factors of BNC.

CONCLUSION

Smaller preoperative prostate volume, smoking history, positive preoperative urine culture, and prolonged postoperative indwelling catheterisation were independent risk factors for BNC.

Evaluation of perioperative risk factors for bladder neck contracture after bipolar transurethral resection of the prostate

PURPOSE

Bladder neck contracture after transurethral resection of the prostate is a common complication but without clear predisposing factors. In this prospective study, we evaluated the perioperative risk factors associated with bladder neck contracture after bipolar transurethral resection of the prostate.

METHODS

The study included 391 patients who were admitted for bipolar transurethral resection of the prostate between October 2020 to October 2023 by three experienced surgeons. Forty three patients had bladder neck contracture and their perioperative parameters were compared with randomly chosen 172 patients without bladder neck contracture.

RESULTS

There were no significant differences between the studied groups regarding the general and present history characteristics. Re-catheterization after transurethral resection of the prostate, post-operative recurrent urinary tract infection, resection speed, and associated urethral stricture were significantly higher among the bladder neck-contraction group (P < 0.05), while total PSA, total prostate weight, post void residual urine volume, resected gland weight, resection time and catheter duration were significantly lower among the bladder neck-contraction group (P < 0.05).

CONCLUSION

Bladder neck contracture after bipolar transurethral resection of the prostate is more common among patients with small fibrotic prostate, low total PSA, small post- void residual urine volume, those with a higher incidence of post-operative recurrent urinary-tract infection and patients with a higher incidence of re-catheterization after transurethral resection of the prostate.

Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study

PURPOSE

Bladder neck contracture (BNC) is a rare but intolerant complication after transurethral surgery of prostate. The present study aims to investigate the incidence and risk factors of BNC in patients diagnosed benign prostate hyperplasia (BPH) and following transurethral resection or enucleation of the prostate (TURP/TUEP).

METHODS

This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients' demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors.

RESULTS

A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8 months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8 months, 35% (7/20) of BNC patients recurred at a median time of 1.8 months.

CONCLUSION

BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.