Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasin...Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.展开更多
BACKGROUND In this article,we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient.CASE SUMMARY The patient,who had a urethral catheter inserted in the pal...BACKGROUND In this article,we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient.CASE SUMMARY The patient,who had a urethral catheter inserted in the palliative service 3 d ago,was consulted because the catheter did not work.Because the fluid given to the bladder could not be recovered,computed tomography was performed,which revealed that the catheter had passed the bladder neck first into the retrovesical area then into the intraabdominal area.The appearance of the anterior urethra and verumontanum was normal at cystoscopy.However,extremely severe stenosis of the bladder neck,and perforated posterior wall of the urethral segment between the prostatic urethra and the bladder neck were observed.Internal urethrotomy was applied to the bladder neck with a urethrotome.An urethral catheter was sent over the guide wire into the bladder.The patient was followed in the palliative care service and the catheter was removed 7 d later.No extravasation was observed in the control urethrography.CONCLUSION Although catheter insertion is a simple and frequently performed procedure in hospitalized patients,it is necessary to avoid unnecessary extra-indication catheter insertion.展开更多
Background: Secondary sclerosis of the bladder neck is a rare but serious late complication that occurs after open or endoscopic prostatic adenomectomy. Objective: The aim of this study was to report the results of en...Background: Secondary sclerosis of the bladder neck is a rare but serious late complication that occurs after open or endoscopic prostatic adenomectomy. Objective: The aim of this study was to report the results of endoscopic management of secondary sclerosis of the bladder neck in a series of 23 cases. Patients and Methods: Cross-sectional study of 23 patients presenting with secondary sclerosis of the bladder neck following adenomectomy and treated by endoscopic resection of the bladder neck in a private facility in Bouaké (Ivory Coast) over the period from 1 January 2021 to 1 December 2022, i.e. 2 years. The mean age of the patients was 61, 7 years with extremes from 53 to 76 years. The diagnosis of secondary sclerosis of the cervix was based on clinical and radiological data (retrograde uretrocystography). The parameters studied were the reason for consultation, time to onset of signs after adenomectomy, clinical data, results of retrograde uretrocystography (RUC), results of urine cytobacteriological examination (UCT), complications, endoscopic procedure, duration of operation, duration of postoperative urinary drainage, duration of hospitalization, postoperative follow-up and operative morbidity and mortality. Results: 23 patients with secondary sclerosis of the bladder neck were treated by endoscopic neck resection. The mean age of the patients was 61.7 years (5 - 76 years). Dysuria was the most frequent reason for consultation, accounting for 73.9% (n = 17). Retrograde uretrocystography (RUC) was used to make the diagnosis in all patients. It found a steam jet image in 69.6% (n = 16) and tight stenosis of the bladder neck in 30.4% (n = 7). Secondary stenosis of the bladder neck was complicated by uretrohydronephrosis in 47.8% (n = 11). 73.9% of patients had a post-micturition residual of more than 150 ml. The urine cytobacteriological examination (UCE) found four urinary tract infections (17.4%) treated with antibiotics over 14 days, which sterilised the urine. The pathologies associated with cervical sclerosis were urethral stricture (13%) treated by endoscopic internal urethrotomy, and urinary lithiasis (8.7%) (n = 2). The mean duration of the operation was 53 minutes (43 - 60 min), the mean duration of postoperative urinary drainage was 3 days (2 - 6 days), and the mean duration of hospitalization was 5.4 days (3 - 6 days). Follow-up at 3 and 6 months using retrograde uretrocystography (RUC) showed good permeability of the neck and urethra with a post-void residual of less than 20 ml (10 - 36 ml). There was no morbidity. Conclusion: Secondary sclerosis of the bladder neck is a late but serious condition because of its obstructive and recurrent nature.展开更多
Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on t...Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.展开更多
Introduction: Smoking is an important risky factor to many diseases, affecting arterial system, skin and urogenital system, including bladder neck stenosis. Its effect on bladder neck has not been described. Objective...Introduction: Smoking is an important risky factor to many diseases, affecting arterial system, skin and urogenital system, including bladder neck stenosis. Its effect on bladder neck has not been described. Objective: Evaluate possible morphological changes caused by nicotine in the bladder neck. Material and Method: Fragments of bladder neck of 16 patients were submitted to stereological analysis, and those patients are divided into two groups, one of smokers and the other of non-smokers with 7 and 9 patients, respectively. After 90 days of surgery, they were submitted to free uroflowmetry and data analyzed by T test, having statistical significance with P 0.05. Results: An increase of 63.26% in the amount of fibers in the elastic system of the smokers group was observed, a reduction of 35.96% in the thickness of arteries, as well as an increase of IPSS and decrease of maximum flow in uroflowmetry, all with statistical significance. Discussion: Laboratorial changes are similar to those found in other studies with different tissues, such as skin, in which those findings are related to premature ageing. Clinical results, though statistically significant, do not have clinical consistence because the study was meant to morphological analysis. Conclusion: Smoking increases the amount of fibers in the elastic system and decreases the thickness of bladder neck arteries.展开更多
Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruc...Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction （BOO） is not clear so far. Video-urodynamic study （VUDS） would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS. Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate （Qmax） less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination （Qmax and residual urine） was recorded 3 months after operation. Results The mean time from its onset to diagnosis was （18.1±9.1） months in 38 patients. Average patient age was 36.1 years （range from 19 to 79 years）. The mean Qrnax was （10.6±4.7） ml/s and residual urine was （81.5±42.4） ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Qmax of （10.8±3.7） ml/s, residual urine of （76.9±32.7） ml and detrusor pressure at maximum flow （Pdet Qmax） of （50.7±19.1） cmH20. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Qrnax was （21.7±7.6） ml/s （P 〈0.01） and the residual urine was （23.2±17.6） ml （P 〈0.01）. Conclusions The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.展开更多
文摘Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.
文摘BACKGROUND In this article,we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient.CASE SUMMARY The patient,who had a urethral catheter inserted in the palliative service 3 d ago,was consulted because the catheter did not work.Because the fluid given to the bladder could not be recovered,computed tomography was performed,which revealed that the catheter had passed the bladder neck first into the retrovesical area then into the intraabdominal area.The appearance of the anterior urethra and verumontanum was normal at cystoscopy.However,extremely severe stenosis of the bladder neck,and perforated posterior wall of the urethral segment between the prostatic urethra and the bladder neck were observed.Internal urethrotomy was applied to the bladder neck with a urethrotome.An urethral catheter was sent over the guide wire into the bladder.The patient was followed in the palliative care service and the catheter was removed 7 d later.No extravasation was observed in the control urethrography.CONCLUSION Although catheter insertion is a simple and frequently performed procedure in hospitalized patients,it is necessary to avoid unnecessary extra-indication catheter insertion.
文摘Background: Secondary sclerosis of the bladder neck is a rare but serious late complication that occurs after open or endoscopic prostatic adenomectomy. Objective: The aim of this study was to report the results of endoscopic management of secondary sclerosis of the bladder neck in a series of 23 cases. Patients and Methods: Cross-sectional study of 23 patients presenting with secondary sclerosis of the bladder neck following adenomectomy and treated by endoscopic resection of the bladder neck in a private facility in Bouaké (Ivory Coast) over the period from 1 January 2021 to 1 December 2022, i.e. 2 years. The mean age of the patients was 61, 7 years with extremes from 53 to 76 years. The diagnosis of secondary sclerosis of the cervix was based on clinical and radiological data (retrograde uretrocystography). The parameters studied were the reason for consultation, time to onset of signs after adenomectomy, clinical data, results of retrograde uretrocystography (RUC), results of urine cytobacteriological examination (UCT), complications, endoscopic procedure, duration of operation, duration of postoperative urinary drainage, duration of hospitalization, postoperative follow-up and operative morbidity and mortality. Results: 23 patients with secondary sclerosis of the bladder neck were treated by endoscopic neck resection. The mean age of the patients was 61.7 years (5 - 76 years). Dysuria was the most frequent reason for consultation, accounting for 73.9% (n = 17). Retrograde uretrocystography (RUC) was used to make the diagnosis in all patients. It found a steam jet image in 69.6% (n = 16) and tight stenosis of the bladder neck in 30.4% (n = 7). Secondary stenosis of the bladder neck was complicated by uretrohydronephrosis in 47.8% (n = 11). 73.9% of patients had a post-micturition residual of more than 150 ml. The urine cytobacteriological examination (UCE) found four urinary tract infections (17.4%) treated with antibiotics over 14 days, which sterilised the urine. The pathologies associated with cervical sclerosis were urethral stricture (13%) treated by endoscopic internal urethrotomy, and urinary lithiasis (8.7%) (n = 2). The mean duration of the operation was 53 minutes (43 - 60 min), the mean duration of postoperative urinary drainage was 3 days (2 - 6 days), and the mean duration of hospitalization was 5.4 days (3 - 6 days). Follow-up at 3 and 6 months using retrograde uretrocystography (RUC) showed good permeability of the neck and urethra with a post-void residual of less than 20 ml (10 - 36 ml). There was no morbidity. Conclusion: Secondary sclerosis of the bladder neck is a late but serious condition because of its obstructive and recurrent nature.
文摘Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.
文摘Introduction: Smoking is an important risky factor to many diseases, affecting arterial system, skin and urogenital system, including bladder neck stenosis. Its effect on bladder neck has not been described. Objective: Evaluate possible morphological changes caused by nicotine in the bladder neck. Material and Method: Fragments of bladder neck of 16 patients were submitted to stereological analysis, and those patients are divided into two groups, one of smokers and the other of non-smokers with 7 and 9 patients, respectively. After 90 days of surgery, they were submitted to free uroflowmetry and data analyzed by T test, having statistical significance with P 0.05. Results: An increase of 63.26% in the amount of fibers in the elastic system of the smokers group was observed, a reduction of 35.96% in the thickness of arteries, as well as an increase of IPSS and decrease of maximum flow in uroflowmetry, all with statistical significance. Discussion: Laboratorial changes are similar to those found in other studies with different tissues, such as skin, in which those findings are related to premature ageing. Clinical results, though statistically significant, do not have clinical consistence because the study was meant to morphological analysis. Conclusion: Smoking increases the amount of fibers in the elastic system and decreases the thickness of bladder neck arteries.
文摘Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction （BOO） is not clear so far. Video-urodynamic study （VUDS） would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS. Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate （Qmax） less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination （Qmax and residual urine） was recorded 3 months after operation. Results The mean time from its onset to diagnosis was （18.1±9.1） months in 38 patients. Average patient age was 36.1 years （range from 19 to 79 years）. The mean Qrnax was （10.6±4.7） ml/s and residual urine was （81.5±42.4） ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Qmax of （10.8±3.7） ml/s, residual urine of （76.9±32.7） ml and detrusor pressure at maximum flow （Pdet Qmax） of （50.7±19.1） cmH20. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Qrnax was （21.7±7.6） ml/s （P 〈0.01） and the residual urine was （23.2±17.6） ml （P 〈0.01）. Conclusions The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.
