SAN DIEGO, CA USA (UroToday.com) - Secondary bladder neck sclerosis (BNS) represents a significant late complication secondary to prostate surgery.
Monopolar transurethral incision (TUI) and transurethral resection (TUR) have been described as the most reliable endoscopic approaches for the management of secondary BNS. The holmium:yttrium–aluminum–garnet (Ho:YAG) and the thulium:yttrium–aluminum–garnet (Th:YAG) lasers have also demonstrated satisfactory postoperative outcomes in BNS treatment. In recent years, Bipolar plasma vaporization (BPV) has become a more popular treatment option for primary treatment of BPH, but has not been well studied for the management of secondary BNS.
Bogdan Geavlete and colleagues performed a single center, prospective, medium-term, randomized trial to assess the therapeutic efficiency, overall safety, and postoperative results of the BPV in comparison to monopolar TUR, in cases of secondary BNS.
The study included a total of 70 patients with BNS secondary to TURP, open prostatectomy for benign prostatic hyperplasia, and radical prostatectomy for prostate cancer. All patients were evaluated preoperatively, as well as at 1, 3, 6, 12, and 18 months after surgery by IPSS quality-of-life score, Qmax, and post-void residual urinary volume.
Their results demonstrated that the mean operative time, catheterization period, and length of hospital stay were significantly lower in the BPV group. During the immediate postoperative period, re-catheterization for acute urinary retention only occurred in the TUR group. The medium term re-treatment rates for BNS recurrence were lower in the BPV study arm. At the 1, 3, 6, 12, and 18-month assessments, there was no significant difference in IPSS and QoL symptom scores, Qmax and PVR values across the two treatment groups. The authors concluded that BPV represents a valuable endoscopic treatment alternative for secondary BNS patients. In this randomized prospective study, BPV demonstrated superior efficacy, satisfactory surgical safety, as well as a similar medium-term improvement in follow-up parameters by comparison with the standard, TUR. Additionally, the new procedure demonstrated significantly decreased operative length, catheterization period, and hospital stay, which represents further arguments for this new procedure. Moreover, the absence of prostatic capsule perforation, intraoperative bleeding, postoperative hematuria, and need for recatheterization for acute urinary retention, substantially contributed to the superior safety profile for the BPV technique.
Presented by Bogdan Geavlete, Cristian Moldoveanu, Catalin Iacoboaie, Florin Stanescu, and Petrisor Geavlete at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Zhamshid Okhunov, MD; UC Irvine Medical Center, Orange, CA USA
