AUA 2013: Post-RP BNC: Broad surgical experience important

Findings from a 15-year retrospective chart review of men treated for recalcitrant post-prostatectomy bladder neck contracture (BNC) and incontinence can provide insight for urologists on expected outcomes for this challenging population.

In addition, the experience reinforces that these men constitute a diverse group of patients who may be optimally managed using a broad armamentarium of surgical techniques, according to researchers from Cleveland Clinic’s Glickman Urological & Kidney Institute Center for Genitourinary Reconstruction, Cleveland.

The study authors identified 63 men who had been referred for recalcitrant BNC (inability to pass a 17F flexible cystoscope) after prior treatment with bladder neck incision (BNI) or dilation. Stress incontinence was the predominant continence complaint.

Management was undertaken in a two-stage sequence, beginning with deep cold-knife BNI. Men returned 3 to 4 months later for cystoscopic evaluation, and those whose BNC was stable and patent were offered further surgery for incontinence with placement of an artificial urinary sphincter or male urethral sling.

BNI was confirmed successful in 46 (73%) of the 63 men, while four men were categorized as BNI failures, and the remaining 13 men were either lost to follow-up with outcome of BNI unknown, still awaiting evaluation after an initial or repeat BNI, or had died. Overall, 42 men (66%) achieved satisfactory continence after BNI and either a single or no additional operation, including 13 men who chose no further surgery after BNI because they were satisfied with their level of continence, 25 of 27 with an artificial sphincter available for follow-up, and four of four men who had a sling procedure.

“To our knowledge, our analysis represents the largest experience with management of post-prostatectomy BNC and incontinence,” said first author Christopher M. Brede, MD, who worked on the study with Kenneth Angermeier, MD, and Hadley Wood, MD. “Based on our findings, we feel confident counseling men that they have at least a two-thirds chance of being satisfied with their level of dryness after BNI alone or with a single additional operation. However, we believe our series also highlights that it is important for reconstructive urologists to be able to offer a range of techniques.”