Neu Sarah, Vigil Humberto, Locke Jennifer A, Herschorn Sender
Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2021 Mar;15(3):E175-E179. doi: 10.5489/cuaj.6644.
We aimed to evaluate the success of bladder neck injections of triamcinolone at the time of transurethral bladder neck incision (BNI) for prevention of recurrent vesicourethral anastomotic stenosis (VUAS) following prostate cancer treatment.
This is a retrospective cohort study examining patients with recurrent VUAS post-radical prostatectomy (RP) ± radiation treated with triamcinolone injections at the time of BNI. VUAS was diagnosed by symptoms followed by cystoscopy or urethrography. The outpatient procedures were done under general anesthesia. Cold knife incisions were made at the three, nine, and 12 o'clock BN positions, followed by triamcinolone injections (4 mg/mL) into the three and nine o'clock incision sites. Treatment outcomes were determined with cystoscopy.
Eighteen men underwent 25 procedures over a four-year period. Median age at diagnosis of VUAS was 65 (interquartile range [IQR] 61-68); median time to VUAS from RP was eight months (IQR 5-12). Fourteen patients (78%) had radiation treatment. The cohort had 128 unsuccessful VUAS treatments, with a median of five failed treatments per patient (IQR 3-10). Failed treatments included BN dilation, BNI, BN injection of mitomycin C, and urethral stent placement. Success rate after a mean of 16.3 months (standard deviation [SD] 8.1) from the time of triamcinolone injection was 83% (15/18). Six patients went on to have successful incontinence surgery. Five patients (28%) had treatment complications (bleeding, urinary tract infection, pain, and urinary extravasation). The three non-responders are stable and awaiting re-treatment with triamcinolone injection.
Triamcinolone bladder neck injections for post-RP VUAS are a useful and safe treatment for recurrent stenosis.
我们旨在评估经尿道膀胱颈切开术（BNI）时膀胱颈注射曲安奈德预防前列腺癌治疗后复发性膀胱尿道吻合口狭窄（VUAS）的成功率。
这是一项回顾性队列研究，研究对象为根治性前列腺切除术（RP）后±接受放疗且在BNI时接受曲安奈德注射治疗的复发性VUAS患者。VUAS通过症状诊断，随后进行膀胱镜检查或尿道造影。门诊手术在全身麻醉下进行。在膀胱颈的三点、九点和十二点位置进行冷刀切开，然后在三点和九点切开部位注射曲安奈德（4mg/mL）。通过膀胱镜检查确定治疗结果。
18名男性在四年期间接受了25次手术。诊断VUAS时的中位年龄为65岁（四分位间距[IQR]61 - 68）；从RP到VUAS的中位时间为8个月（IQR 5 - 12）。14名患者（78%）接受了放疗。该队列有128次VUAS治疗失败，每位患者失败治疗的中位数为5次（IQR 3 - 10）。失败的治疗包括膀胱颈扩张、BNI、膀胱颈注射丝裂霉素C和尿道支架置入。曲安奈德注射后平均16.3个月（标准差[SD]8.1）的成功率为83%（15/18）。6名患者随后成功进行了尿失禁手术。5名患者（28%）出现治疗并发症（出血、尿路感染、疼痛和尿外渗）。三名无反应者情况稳定，等待再次接受曲安奈德注射治疗。
RP后VUAS的曲安奈德膀胱颈注射是复发性狭窄的一种有效且安全的治疗方法。
