Surgical repair of recurrent bladder neck Obstruction after radical Prostatectomy via perineal approch
Surgical repair of recurrent bladder neck obstruction after radical prostatectomy via perineal approach
J. Beier1, H. Keller1
1Sana Klinikum Hof GmbH, Klinik für Urologie, Kinderurologie, Urologische Onkologie und Palliativmedizin, Hof,
Bladder neck obstruction (BNO) after RPE occurs in up to 15 % of cases and can be treated by dilation and bladder neck incision. Nevertheless a certain amount recurs and needs open reconstruction.
Material and methods:
In case of recurrent BNO we perform open resection of the scared tissue and perform a realignment of the urethra with the healthy tissue of the bladder neck (BN). The patient is positioned in exaggerated lithotomy position. To prevent injury of the ureteral orifice we insert singleJ-catheters in both ureters and drain them suprapubically. A curved lowsley protractor is introduced. We use headlight, 4x magnifying glasses and a self-retaining-system. Skin-incision is performed semicircular around the anus, the BN and urethra are developed, the urethra is transected at the BN and the bladder is mobilized circumferentially by the use of the bipolar scissor. The scared tissue is completely removed. Anastomosis is performed after inserting a 18 Fr. catheter which is kept in place for 3 weeks. After 2 weeks the single-J-catheters are removed.
All 15 our patients went well with no complications and no transfusions were necessary. One of our patients developed a recurrence and 7 out of 15 complained about incontinence.
In case of recurrent BNO, perineal resection of the scared tissue and realignment can be performed minimally invasive with high success-rate. We feel, that insertion of single-J-catheters draining suprapubically, the use of a self-retrainingsystem, headlights and 4x magnifying glasses is very helpful, as well - as our experience with more than 2500 perineal RPE. We recommend not to do more than 1 or 2 bladder neck incisions or dilatations and to go straight forward to open reconstruction.