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Bladder Neck Stenosis

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Margit Fisch – One of the best experts on this subject based on the ideXlab platform.

  • The T-plasty as therapy for recurrent Bladder Neck Stenosis: success rate, functional outcome, and patient satisfaction
    World Journal of Urology, 2017
    Co-Authors: Clemens M. Rosenbaum, Margit Fisch, Roland Dahlem, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, C. Philip Reiss

    Abstract:

    Purpose To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the Bladder Neck in case of recurrent Bladder Neck Stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. Patients and methods We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients’ charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Results Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62–73) years. Most patients had BNS due to TUR-P [ n  = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18–64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q _max, mean Q _max post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; ( t (5) = 4.12, p  = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; ( t (9) = −3.86, p  = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. Conclusions The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

  • the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
    World Journal of Urology, 2017
    Co-Authors: Clemens M. Rosenbaum, Margit Fisch, Roland Dahlem, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C Reiss

    Abstract:

    To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the Bladder Neck in case of recurrent Bladder Neck Stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients’ charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62–73) years. Most patients had BNS due to TUR-P [n = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18–64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q
    max, mean Q
    max post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; (t(5) = 4.12, p = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; (t(9) = −3.86, p = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

  • differences in recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral Stenosis and Bladder Neck Stenosis
    Frontiers in Surgery, 2017
    Co-Authors: J Kranz, Margit Fisch, Philipp Reiss, Georg Salomon, Joachim Steffens, Clemens M. Rosenbaum

    Abstract:

    Objectives: The objective of this study was to compare the recurrence rate and de-novo incontinence after endoscopic treatment of vesicourethral Stenosis (VUS) after radical prostatectomy (RP) and for Bladder Neck Stenosis (BNS) after transurethral resection of the prostate (TURP). Methods: Retrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de-novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups. Results: A total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44-86), mean FU 27.1 months (1-98). Mean time to recurrence after initial therapy was 23.9 months (1-156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1-159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p=0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; p=0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p=0.031). Mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de-novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p=0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p=0.091), whereas the rate of de-novo incontinence (13.8 for VUS vs. 0% for BNS; p=0.005) stayed significantly higher in patients treated for VUS. Conclusions: Most patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to de-novo incontinence. Patients must be counselled regarding the increased risk of de-novo incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.

Clemens M. Rosenbaum – One of the best experts on this subject based on the ideXlab platform.

  • The T-plasty as therapy for recurrent Bladder Neck Stenosis: success rate, functional outcome, and patient satisfaction
    World Journal of Urology, 2017
    Co-Authors: Clemens M. Rosenbaum, Margit Fisch, Roland Dahlem, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, C. Philip Reiss

    Abstract:

    Purpose To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the Bladder Neck in case of recurrent Bladder Neck Stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. Patients and methods We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients’ charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Results Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62–73) years. Most patients had BNS due to TUR-P [ n  = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18–64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q _max, mean Q _max post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; ( t (5) = 4.12, p  = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; ( t (9) = −3.86, p  = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. Conclusions The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

  • the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
    World Journal of Urology, 2017
    Co-Authors: Clemens M. Rosenbaum, Margit Fisch, Roland Dahlem, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C Reiss

    Abstract:

    To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the Bladder Neck in case of recurrent Bladder Neck Stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients’ charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62–73) years. Most patients had BNS due to TUR-P [n = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18–64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q
    max, mean Q
    max post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; (t(5) = 4.12, p = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; (t(9) = −3.86, p = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

  • differences in recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral Stenosis and Bladder Neck Stenosis
    Frontiers in Surgery, 2017
    Co-Authors: J Kranz, Margit Fisch, Philipp Reiss, Georg Salomon, Joachim Steffens, Clemens M. Rosenbaum

    Abstract:

    Objectives: The objective of this study was to compare the recurrence rate and de-novo incontinence after endoscopic treatment of vesicourethral Stenosis (VUS) after radical prostatectomy (RP) and for Bladder Neck Stenosis (BNS) after transurethral resection of the prostate (TURP). Methods: Retrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de-novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups. Results: A total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44-86), mean FU 27.1 months (1-98). Mean time to recurrence after initial therapy was 23.9 months (1-156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1-159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p=0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; p=0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p=0.031). Mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de-novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p=0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p=0.091), whereas the rate of de-novo incontinence (13.8 for VUS vs. 0% for BNS; p=0.005) stayed significantly higher in patients treated for VUS. Conclusions: Most patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to de-novo incontinence. Patients must be counselled regarding the increased risk of de-novo incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.

Roland Dahlem – One of the best experts on this subject based on the ideXlab platform.

  • The T-plasty as therapy for recurrent Bladder Neck Stenosis: success rate, functional outcome, and patient satisfaction
    World Journal of Urology, 2017
    Co-Authors: Clemens M. Rosenbaum, Margit Fisch, Roland Dahlem, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, C. Philip Reiss

    Abstract:

    Purpose To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the Bladder Neck in case of recurrent Bladder Neck Stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. Patients and methods We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients’ charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Results Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62–73) years. Most patients had BNS due to TUR-P [ n  = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18–64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q _max, mean Q _max post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; ( t (5) = 4.12, p  = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; ( t (9) = −3.86, p  = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. Conclusions The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

  • the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
    World Journal of Urology, 2017
    Co-Authors: Clemens M. Rosenbaum, Margit Fisch, Roland Dahlem, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C Reiss

    Abstract:

    To determine success rate (SR), functional outcome, and patient satisfaction of a modified YV-plasty for reconstruction of the Bladder Neck in case of recurrent Bladder Neck Stenosis (BNS) after transurethral surgery of the prostate: the T-plasty. We identified all patients who underwent T-plasty at our center between December 2008 and July 2016. Patients’ charts were reviewed. Patients were queried by telephone and by mail at time of follow-up (FU). Primary endpoint was SR. Secondary endpoints were complications, continence, satisfaction, and changes in quality of life measured by validated questionnaires. Thirty patients underwent the T-plasty. Median age at surgery was 69 (IQR 62–73) years. Most patients had BNS due to TUR-P [n = 25 (83.3%)]. No severe blood loss or severe complications occurred perioperatively. Median FU was 45 (IQR 18–64) months. Three patients were lost to FU. Success rate was 100%. Compared to pre-OP Q
    max, mean Q
    max post-OP improved significantly [pre-OP 6.79 (SD ± 4.76) ml/s vs post-OP was 24.42 (SD ± 12.61) ml/s; (t(5) = 4.12, p = 0.009)]. Mean post-void residual urine decreased significantly [pre-OP 140.77 (SD ± 105.41) ml vs post-OP 14.5 (SD ± 22.42) ml; (t(9) = −3.86, p = 0.004)]. One patient developed a de-novo-incontinence post-OP. Mean ICIQ-SF Score was 1.2 (SD ± 2.27). 88.5% of patients were pleased or delighted by surgery. 75% of patients claimed their quality of life has been (strongly) improved. The T-plasty is a valuable option as treatment of recurrent BNS. SR, rates of continence, and high patient satisfaction are very encouraging.

  • open retropubic reanastomosis for highly recurrent and complex Bladder Neck Stenosis
    The Journal of Urology, 2011
    Co-Authors: Daniel Pfalzgraf, Maike Beuke, Hendrik Isbarn, Christoph Philip Reiss, Wolfhartmut Meyermoldenhauer, Roland Dahlem, Margit Fisch

    Abstract:

    Purpose: We assessed the success rate of open reanastomosis for highly recurrent Bladder Neck Stenosis resistant to transurethral treatment. Due to the paucity of available data the success rate of this procedure is not well defined, although it can be a last treatment option before urinary diversion.Materials and Methods: A total of 158 patients were treated for Bladder Neck Stenosis in 1998 to 2007, of whom 20 underwent open reanastomosis for highly recurrent or complex Bladder Neck Stenosis after radical prostatectomy and were seen for followup 3 months postoperatively. They received a standardized questionnaire at the time of data acquisition in this retrospective analysis.Results: The 20 patients underwent a mean of 3.7 previous surgeries. Median followup was 59.2 months. Stenosis recurred after reanastomosis in 8 patients (40%) while the remaining 60% were recurrence free. Seven recurrences were successfully treated endoscopically, resulting in an overall combined 95% success rate. Urinary diversion…