The efficacy of bladder neck incision with intralesional steroid injection for the treatment of recurrent bladder neck contracture following radical prostatectomy
Dr. Jordan Mann (1), Mr. Andre Westenberg (1)
(1) Bay Of Plenty District Health Board, , New Zealand
Bladder neck contracture (BNC) following radical prostatectomy (RP) is a relatively common problem that negatively impacts men’s quality of life. It can often be successfully managed with a single dilation or endoscopic incision, but in a minority of patients it recurs. After failing endoscopic management, further attempts are likely to be futile and can become extremely difficult to manage. We evaluated the efficacy of intralesional steroid injection performed at the time of BNI for recalcitrant BNC following RP
We performed a retrospective review of all patients that underwent BNI and intralesional steroid injection for recurrent BNC between November 2011 and March 2018. BNC was diagnosed endoscopically and identified as recalcitrant if having previously failed endoscopic management with BNI alone. Follow-up was initially performed at 3 months with an IPSS and urinary flow rate, unless clinically required earlier. Patients were noted to be recurrence free when discharged from follow up or having undergone a continence procedure indicating stability of the contracture.
Thirty patients underwent BNI and intralesional steroid injection for recurrent BNC over the study period. 70.0% (21/30) of patients were recurrence-free post procedure, and this increased to 83.3% (25/30) after a repeat procedure in four patients. All five patients that had previous salvage radiotherapy had their recurrent BNC successfully managed with one BNI and intralesional steroid injection. The mean follow-up was 33.4 months (range 7 – 75). There were no adverse events recorded.
Bladder neck incision with injection of intralesional steroids is a simple, cost-effective intervention which requires no specialist equipment/skills outside the realm of a general urologist. We have shown it to be safe and have an excellent success rate when compared to BNI alone.