SUFU 2020: Very Long-term Follow-up in the Management of Complex Bladder Neck Contracture and Urinary Incontinence After Prostate Cancer Treatment: Lessons Learned

Scottsdale, AZ ( Dr. Angelo Gousse presented his experience with 2-stage management for complex refractory bladder neck contracture (BNC) after prostate cancer treatment (PPcaT) associated with urinary incontinence.

This was a 12-year retrospective electronic medical record review that was performed on patients with stress urinary incontinence (SUI) associated with complex BNC after PPCaT. Treatment consisted of deep hot-knife Bladder Neck Incision (BNI) or resection (TURBNC), followed by cystoscopy at 2 months. If stable, healed, and patent, an artificial urinary sphincter (AUS - AMS 800) was placed. Recurrent BNC at 2 months was treated with a second BNI or a 3rd BNI until patency was achieved.

There were 88 Patients with BNC and urinary incontinence (UI) were identified with a median age of 75 (58 - 93) years, body mass index 31.1 (21.8-66.8) kg/m2, and a median follow-up of 66 (6-118) months. 60/88 (68.1%) underwent Radical Prostatectomy (RRP) and radiation treatment and 28 /88 (31.8%) RRP alone. Of the 88 patients who had successful management of the BNC,63/88 (71.6%) underwent AUS-AMS 800 by a single surgeon (AEG). The remaining declined or were unable to proceed for various health reasons. 44/63 who underwent AUS (69.8%) had a history of radiation resulting in 8/63 poor outcomes leading to AUS removal:6 Erosions,1 persisting severe incontinence,1 device scrotal infection. Of the 19/63 (30.2%) non-radiated patients who underwent AUS there were 5 poor outcomes: 4 erosions related to transurethral manipulations by non-urology providers, 1 Fistula. Symptomatic recurrent BNC after AUS implantation was noted in 15/88 (17%) patients:10 in radiated patients and 5 in non-radiated patients. Recurrent BNC post AUS was successfully treated using a 12Fr resectoscope/hot knife in all cases. No erosion resulted from post-AUS transurethral BNI. Only 3 patients required more than 2 BNC post AUS. An AUS was never removed to manage BNC. No patient required urinary diversion. The overall long-term success rate was 84. 5% (continent defined less than 2 pads per day) and patent bladder neck.

Dr. Gousse reports that this is the largest series with the longest follow-up for the management of complex BNC and SUI after PPcaT. He concluded that patients can be safely managed with hot-knife incision, followed by AUS, with a majority of cases achieving continence and outlet patency.

Presented by: Angelo Gousse, MD

Co-Author: Jan-Michael Pohudka1

1. Bladder Health & Reconstructive Urology Institute, Florida 

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona