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Sources of Funding: None

Introduction

The treatment of bladder neck contracture (BNC) after BPH surgery is challenging and may even require open reconstructive surgery in patients that whish to avoid chronic catheterization or suprapubic urinary diversion. The aim of this study is to introduce a novel surgical technique for the reconstruction of refractory BNC using buccal mucosal graft (BMG) inlay through a transvesical approach.

Methods

We performed a retrospective analysis of patients that underwent open reconstructive surgery for refractory BNC after BPH surgery from 2010-2016 by a single surgeon (BJF). Steps of the procedure: transvesical ventral wedge resection of the fibrotic bladder neck contracture and spread fixation of appropriately sized BMG inlay. The patients were followed for post-operative complications and stricture recurrence with uroflowemtry, PVR, cystoscopy and outcome questionnaires. Outcome measures included length of follow-up, surgical technique, operative time, hospital stay, complications, and subsequent need for catheterization

Results

A total of 13 patients presented refractory BNC of which 11 were suitable for reconstruction and 2 required urinary diversion. Eleven patients underwent reconstruction underwent transvesical ventral buccal mucosa graft inlay cystoplasty. Prior BPH surgery included transurethral resection of the prostate (64%), plasma vaporization of prostate (27%), and open prostatectomy (9.1%). Urinary retention (82%) was the most common presenting symptom and 73% of patients were using a catheter (Foley, suprapubic, self-catheterization) pre-operatively. An average of 2.3 endoscopic procedures were performed before BNC reconstruction. Overall, BNC diameter was 9.1 Fr. The average BMG size was 11.3 cm2, operative time was 298 minutes, and hospital stay was 3.3 days. Post-operatively, four patients had transient urinary retention and two had epididymorchytis. At a mean follow-up of 1.2 (0-5.1) years, only one patient had chronic retention and was considered a failure and remains dependent on self-catheterization.

Conclusions

BNC after BPH surgery is challenging surgical issue. Transvesical ventral BMG inlay cystoplasty is a feasible option that effectively treats refractory BNC. This graft augmentation technique using buccal mucosa graft provide good outcomes with low morbidity for patients that failed multiple endoscopic treatments

Funding

None