Open Repair of Bladder Neck Contractures (BNC) with or without Adjuvant Radiotherapy
Author(s):
Miss Stella Ivaz
,
Miss Stella Ivaz
Affiliations:
Mr Simon Bugeja
,
Mr Simon Bugeja
Affiliations:
Miss Stacey Frost
,
Miss Stacey Frost
Affiliations:
Miss Mariya Dragova
,
Miss Mariya Dragova
Affiliations:
Miss Daniela E Andrich
,
Miss Daniela E Andrich
Affiliations:
Prof Anthony R Mundy
Prof Anthony R Mundy
Affiliations:
BAUS ePoster online library. Frost A. 06/27/17; 177371; P4-5
Dr. Anastasia Frost
Dr. Anastasia Frost
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Abstract
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Introduction

BNC occur in approximately 0.4-32% of patients after radical prostatectomy(RP). The majority are managed endoscopically but a small number are refractory to all forms of treatment. This study describes our experience in this group of patients.

Patients and Methods

42 patients presented with refractory BNC between March ’07-March ’15. 32 had RP alone. 10 had RP and adjuvantsalvage radiotherapy. Revision surgery was performed through a transperineal approach. An artificial sphincter (AUS) was implanted 3-6months later to restore continence.

Results

31 (97%) of 32 post-surgical patients had a successful outcome. 3 had simultaneous urorectal fistula repair. Of the 10 radiotherapy patients, 7 had a patent anastomosis and 6 (60%) of these were dry following AUS implantation. 1 other patient had 4 consecutive sphincters which all eroded. 1 patient developed re-stenosis and was managed by suprapubic catheterisation. Two had incomplete healing of their anastomosis and developed a urosymphyseal fistula.

Conclusion

Patients with recalcitrant BNC after RP with no radiotherapy can be treated by revision of the vesico-urethral anastomosis with very satisfactory results. Some carefully selected patients who have had radiotherapy can also be treated in the same way but there should be careful evaluation of the state of the pubispubic symphysis preoperatively and urodynamic evaluation of bladder function, to avoid the very poor outcome in patients failing such surgery.

Patients must be counselled that this will almost certainly be a two-stage reconstruction; first to dis-obstruct them and then to implant an AUS for the almost inevitable resulting incontinence.
Introduction

BNC occur in approximately 0.4-32% of patients after radical prostatectomy(RP). The majority are managed endoscopically but a small number are refractory to all forms of treatment. This study describes our experience in this group of patients.

Patients and Methods

42 patients presented with refractory BNC between March ’07-March ’15. 32 had RP alone. 10 had RP and adjuvantsalvage radiotherapy. Revision surgery was performed through a transperineal approach. An artificial sphincter (AUS) was implanted 3-6months later to restore continence.

Results

31 (97%) of 32 post-surgical patients had a successful outcome. 3 had simultaneous urorectal fistula repair. Of the 10 radiotherapy patients, 7 had a patent anastomosis and 6 (60%) of these were dry following AUS implantation. 1 other patient had 4 consecutive sphincters which all eroded. 1 patient developed re-stenosis and was managed by suprapubic catheterisation. Two had incomplete healing of their anastomosis and developed a urosymphyseal fistula.

Conclusion

Patients with recalcitrant BNC after RP with no radiotherapy can be treated by revision of the vesico-urethral anastomosis with very satisfactory results. Some carefully selected patients who have had radiotherapy can also be treated in the same way but there should be careful evaluation of the state of the pubispubic symphysis preoperatively and urodynamic evaluation of bladder function, to avoid the very poor outcome in patients failing such surgery.

Patients must be counselled that this will almost certainly be a two-stage reconstruction; first to dis-obstruct them and then to implant an AUS for the almost inevitable resulting incontinence.
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