Nealon Samantha W, Bhanvadia Raj R, Badkhshan Shervin, Sanders Sarah C, Hudak Steven J, Morey Allen F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
J Clin Med. 2022 Jul 27;11(15):4355. doi: 10.3390/jcm11154355.
To present our 12-year experience using an endoscopic approach to manage bladder neck contracture (BNC) without adjunctive intralesional agents and compare it to published series not incorporating them, we retrospectively reviewed 123 patients treated for BNC from 2008 to 2020. All underwent 24 Fr balloon dilation followed by transurethral incision of BNC (TUIBNC) with deep incisions at 3 and 9 o'clock using a Collins knife without the use of intralesional injections. Success was defined as a patent bladder neck and 16 Fr cystoscope passage into the bladder two months later. Most with recurrent BNC underwent repeat TUIBNC. Success rates, demographics, and BNC characteristics were analyzed. The etiology of BNC in our cohort was most commonly radical prostatectomy with or without radiation (36/123, 29.3%, 40/123, 32.5%). Some had BNC treatment prior to referral (30/123, 24.4%). At 12-month follow-up, bladder neck patency was observed in 101/123 (82.1%) after one TUIBNC. An additional 15 patients (116/123, 94.3%) had success after two TUIBNCs. On univariate and multivariate analyses, ≥2 endoscopic treatments was the only factor associated with failure. TUIBNC via balloon dilation and deep bilateral incisions without the use of adjunctive intralesional injections has a high patency rate. History of two or more prior endoscopic procedures is associated with failure.
为了介绍我们12年来使用内镜方法处理膀胱颈挛缩（BNC）且不使用辅助病灶内注射药物的经验，并将其与未采用这些方法的已发表系列研究进行比较，我们回顾性分析了2008年至2020年期间接受BNC治疗的123例患者。所有患者均接受了24F球囊扩张，随后使用柯林斯刀在3点和9点处进行膀胱颈经尿道切开术（TUIBNC），且未使用病灶内注射。成功的定义为膀胱颈通畅且两个月后能通过16F膀胱镜进入膀胱。大多数复发性BNC患者接受了重复TUIBNC。分析了成功率、人口统计学特征和BNC特点。我们队列中BNC的病因最常见的是根治性前列腺切除术伴或不伴放疗（36/123，29.3%；40/123，32.5%）。一些患者在转诊前已接受过BNC治疗（30/123，24.4%）。在12个月的随访中，一次TUIBNC后，123例中有101例（82.1%）观察到膀胱颈通畅。另外15例患者（123例中的116例，94.3%）在两次TUIBNC后获得成功。单因素和多因素分析显示，≥2次内镜治疗是与失败相关的唯一因素。通过球囊扩张和双侧深部切开进行TUIBNC且不使用辅助病灶内注射药物具有较高的通畅率。既往有两次或更多次内镜手术史与失败相关。
