Introduction

The natural history of endoscopic treatment for recurrent bladder neck contracture (BNC) after radical prostatectomy (RP) and predictors of treatment failure have been poorly studied. Using the largest known series of post-RP BNC series to date, we sought to assess long-term success of the initial endoscopic treatments for BNC and to identify factors that predict endoscopic treatment failure.

Methods

Between January 2005 and December 2014, we retrospectively reviewed 6,179 RP cases, and identified 302 incidents of BNC. BNC was defined as a symptomatic, cystoscopically confirmed narrowing of the bladder neck that occurred after prostatectomy. After exclusion criteria, 237 were available for analysis. Patient characteristics, prostatectomy technique, post-prostatectomy complications, and endoscopic treatment type were assessed for their association with endoscopic treatment failure. Endoscopic treatment success was defined as BNC resolution after ≤2 endoscopic treatments. The Kaplan-Meier method and log rank test were used to evaluate 5-year endoscopic treatment success over time. Multivariable Cox regression was performed to identify independent predictors of treatment failure.

Results

5-year endoscopic treatment success was 76.7% after two procedures and 40.7% after one procedure. Median follow up was 54.5 months. The median time to BNC diagnosis was 2.9 months. Endoscopic treatment type (dilation vs. hot incision vs. cold incision) was not associated with treatment success after the first (p=0.86) or second (p=.27) treatment. On multivariable analysis, independent predictors of endoscopic treatment failure were non-nerve-sparing prostatectomy technique (HR 2.22, 95% CI 1.21-4.07, p=0.01) and post-prostatectomy urine leak (HR 2.74, 95% CI 1.42-5.29, p<0.01). Interestingly, prior radiation, surgical approach, bladder neck reconstruction and transfusion did not predict BNC treatment failure. [Table 1]

Conclusions

Endoscopic treatment is an effective management option for most post-prostatectomy BNC with promising 5-year outcomes. Non-nerve-sparing prostatectomy technique and post-prostatectomy urine leak predict endoscopic treatment failure. Patients with these factors are at greatest risk for requiring multiple treatments.

Funding

None