Comparison of endoscopic treatment for bladder neck contracture: a single centre study and review of literature

OBJECTIVES: Nowadays, bladder neck contracture treatment reported is both bladder neck incisions and resection. Also, different energies have been described. This study aimed to describe and compare surgical techniques and energy sources used in Hospital Universitari de Vic. METHODS: retrospective study of patients with a diagnosis of bladder neck contracture that required endoscopic surgical treatment between 2000 and 2024. Preoperative, operative, and postoperative characteristics were analysed. At the end of follow-up, the patient's status was asymptomatic, under urethral dilatations, or with a permanent catheter. RESULTS: 60 patients were included. Mean age was 71.1 years (SD = 8.95). Previous urologic surgery was open radical prostatectomy (33.3%), laparoscopic radical prostatectomy (6.7%), transurethral resection of the prostate (31.7%), laser prostate vaporization (16.7%), open prostate adenomectomy (6.7%), and transurethral resection of bladder tumour (5.0%). Concomitant urethral stricture was detected in 21.3%. Bladder neck resection was used in 41.7% and bladder neck incisions at 12, 5, and 7 h in 58.3%. No significant difference in success rate was detected (p = 0.598). The instrument was monopolar loop (31.7%), Collins (41.7%), cold knife (11.7%), bipolar loop (8.3%), and Holmium laser (6.7%). In 13 patients, a second endoscopic management was performed, and 9 presented success. Median time follow-up was 63 months (IQR: 25-100). Patient's clinical situation was asymptomatic in 71.1%, periodic dilatations in 25% and a permanent catheter in 3.3%. The only risk factor detected for periodic dilatations was urethral stenosis. CONCLUSIONS: Endoscopic treatment presents a success rate of 71% at 5 years with no significant difference between bladder neck incisions or resection, nor between previous types of prostate surgery.