Luca Cindolo1, Michele Marchioni2, Esteban Emiliani3, Piergustavo DE Francesco2, Giulia Primiceri2, Pietro Castellan4, Luigi Schips4. 1. Robotic Unit, Department of Urology, ASL Abruzzo 2, SS. Annunziata Hospital, Chieti, Italy - lucacindolo@virgilio.it. 2. Department of Urology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy. 3. Department of Urology, Tenon Hospital, Université Pierre et Marie Curie Paris IV, Paris, France. 4. Robotic Unit, Department of Urology, ASL Abruzzo 2, SS. Annunziata Hospital, Chieti, Italy.
Abstract
INTRODUCTION: Over the last few decades, numerous surgical procedures have been proposed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, all are characterized by a certain rate of treatment failure due to bladder neck contracture (BNC). Treatment of secondary BNC appears to be challenging. The main purpose of this review is to evaluate current published knowledge on this topic. EVIDENCE ACQUISITION: The MEDLINE/PubMed database was searched for all original articles published between 2000 and 2016 analyzing the incidence, prevalence and management of BNC as a post-operative complication following surgical treatment of LUTS/BPH. Prospectively designed studies, and those with prospectively maintained databases and/or rigorous inclusion and exclusion criteria were included. Given the lack of prospective studies examining treatment options for BNC, retrospective studies were also included in this section. EVIDENCE SYNTHESIS: Thirty-four studies were included. The huge heterogeneity of patients, gland characteristics, surgical strategies and follow-up procedures limited the overall quality of results. BNC incidence after surgery for LUTS/BPH ranges from 0% to 9.6%. Given the dearth of well-designed studies, it seems rational to leave the choice of treatment procedure to the specialist's own decision. CONCLUSIONS: BNC incidence varies greatly depending on the examined cohorts, with only few precautionary measures available for prevention. Treatment is challenging and it seems reasonable to leave the choice of BNC treatment technique to the surgeon's own judgement.
INTRODUCTION: Over the last few decades, numerous surgical procedures have been proposed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, all are characterized by a certain rate of treatment failure due to bladder neck contracture (BNC). Treatment of secondary BNC appears to be challenging. The main purpose of this review is to evaluate current published knowledge on this topic. EVIDENCE ACQUISITION: The MEDLINE/PubMed database was searched for all original articles published between 2000 and 2016 analyzing the incidence, prevalence and management of BNC as a post-operative complication following surgical treatment of LUTS/BPH. Prospectively designed studies, and those with prospectively maintained databases and/or rigorous inclusion and exclusion criteria were included. Given the lack of prospective studies examining treatment options for BNC, retrospective studies were also included in this section. EVIDENCE SYNTHESIS: Thirty-four studies were included. The huge heterogeneity of patients, gland characteristics, surgical strategies and follow-up procedures limited the overall quality of results. BNC incidence after surgery for LUTS/BPH ranges from 0% to 9.6%. Given the dearth of well-designed studies, it seems rational to leave the choice of treatment procedure to the specialist's own decision. CONCLUSIONS: BNC incidence varies greatly depending on the examined cohorts, with only few precautionary measures available for prevention. Treatment is challenging and it seems reasonable to leave the choice of BNC treatment technique to the surgeon's own judgement.
Authors: Luca Cindolo; Cosimo De Nunzio; Francesco Greco; Paolo Destefanis; Franco Bergamaschi; Giovanni Ferrari; Giuseppe Fasolis; Fabiano Palmieri; Claudio Divan; Rino Oriti; Lorenzo Ruggera; Andrea Tubaro; Claudio Dadone; Gaetano De Rienzo; Antonio Frattini; Vincenzo Mirone; Luigi Schips Journal: World J Urol Date: 2017-11-01 Impact factor: 4.226