Login to Access Video or Poster Abstract: MP36-17
Sources of Funding: None

Introduction

Highly recurrent bladder neck stenosis (BNS) after surgery for benign prostatic hyperplasia (BPH) is a rare but troublesome problem. After multiple endoscopic treatment attempts, open surgery can be the last therapeutic option before urinary diversion. We present the extended follow-up of outcome and patient`s satisfaction of the previously described T-plasty: A modified YV-plasty of the bladder neck in patients with highly recurrent BNS.

Methods

In all, 30 patients who underwent T-plasty between December 2008 and July 2016 were retrospectively identified from our prospective urethroplasty data base. Patients were interviewed by telephone. Primary end point of was the treatment specific success rate defined as bladder neck patency without any history of recurrent stenosis or need of further intervention. Secondary endpoint was patient related outcome measurement.

Results

Mean age was 68.3 yrs. (range 47-86), mean follow up was 44.9 months (range 2-92). As initial surgery for BPH, 83.3% of patients (n=25) had a TURP, 10% had a HoLEP (n=3) and 6.7% had a Greenlight-Laser (n=2). Mean number of prior transurethral procedures to treat the BNS was 4.6 (range 1-19). Preoperatively mean Qmax was 6.8 ml/sec, mean post void residual volume was 141ml. _x000D_ Mean time of surgery was 111 min. (range 74-175). There was no relevant blood loss. No postoperative complications higher grad II according to Clavien-Dindo occurred. Mean time of hospital stay was 13.2 days (range 8-21). _x000D_ Success rate was 100%, one patient needed a permanent catheter due to acontractile detrusor. In one patient, preexisting stress incontinence increased. No de-novo stress incontinence occurred. In no patient further endoscopic or surgical treatment was needed. Postoperatively mean Qmax was 19.8 ml/sec, mean post void residual volume was 37ml. Both values were significantly improved compared to preoperative measurements (p=0.019 and p=0.01). _x000D_ In all 87.5% of patients were (very) satisfied. Only one patient was dissatisfied. In this patient preexisting stress incontinence increased postoperatively. Number of prior therapies did not correlate with patient`s satisfaction. _x000D_

Conclusions

The T-plasty represents a successful and safe procedure to treat highly recurrent BNS after surgery for BPH. Success rate is 100%, no major complications were seen. The T-plasty improves quality of life with good satisfaction rates.

Funding

None