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Margit Fisch - One of the best experts on this subject based on the ideXlab platform.
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The T-plasty as therapy for recurrent Bladder Neck Stenosis: success rate, functional outcome, and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, C. Philip ReissAbstract: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.
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the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C ReissAbstract: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.
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differences in recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral Stenosis and Bladder Neck Stenosis
Frontiers in Surgery, 2017Co-Authors: J Kranz, Margit Fisch, Philipp Reiss, Georg Salomon, Joachim Steffens, Clemens M. RosenbaumAbstract: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.
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open retropubic reanastomosis for highly recurrent and complex Bladder Neck Stenosis
The Journal of Urology, 2011Co-Authors: Daniel Pfalzgraf, Maike Beuke, Hendrik Isbarn, Christoph Philip Reiss, Wolfhartmut Meyermoldenhauer, Roland Dahlem, Margit FischAbstract: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...
Clemens M. Rosenbaum - One of the best experts on this subject based on the ideXlab platform.
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The T-plasty as therapy for recurrent Bladder Neck Stenosis: success rate, functional outcome, and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, C. Philip ReissAbstract: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.
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the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C ReissAbstract: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.
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differences in recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral Stenosis and Bladder Neck Stenosis
Frontiers in Surgery, 2017Co-Authors: J Kranz, Margit Fisch, Philipp Reiss, Georg Salomon, Joachim Steffens, Clemens M. RosenbaumAbstract: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.
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The T-plasty as therapy for recurrent Bladder Neck Stenosis: success rate, functional outcome, and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, C. Philip ReissAbstract: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.
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the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C ReissAbstract: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.
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open retropubic reanastomosis for highly recurrent and complex Bladder Neck Stenosis
The Journal of Urology, 2011Co-Authors: Daniel Pfalzgraf, Maike Beuke, Hendrik Isbarn, Christoph Philip Reiss, Wolfhartmut Meyermoldenhauer, Roland Dahlem, Margit FischAbstract: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...
I Perkash - One of the best experts on this subject based on the ideXlab platform.
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Contact laser sphincterotomy: further experience and longer follow-up
Spinal Cord, 1996Co-Authors: I PerkashAbstract:I report here the use of a crystal chisel contact tip firing Nd:YAG laser for transurethral sphincterotomy in 76 consecutive spinal cord injury patients. Their mean age was 53 years (range 26 to 77 years). Fifty-four (72%) were complete motor (Frankel A and B) and 21 (28%) were incomplete lesions (Frankel C and D) They were evaluated with multichannel urodynamic equipment and 89% of the patients showed detrusor sphincter dyssynergia and 11% showed detrusor areflexia. Forty-three patients (56%) had previous electrocautery sphincterotomy and were not voiding well. A cystoscopic examination showed that 32% had an associated enlarged prostate and/or Bladder-Neck Stenosis and 32% had associated wide-body strictures in the bulbous urethra. The crystal chisel contact tip-firing Nd:YAG laser almost mimicked a hot diathermy knife to create an intraurethral incision as well as vaporizing the tissues. For sphincterotomy, a 12 o'clock incision was used from the verumontanum to the bulbous urethra. In patients with an associated enlarged prostate or bulging lateral lobes, 3 and 9 o'clock incisions were also made from the Bladder-Neck to the verumontanum and also vaporized the bulging prostate tissue. We used 25 to 40 watts for cutting, and vaporization of tissue and 15-25 watts to stop bleeding. The blood loss was less than 50 ml at surgery in 97.4% patients. None of the patients were transfused. An indwelling Foley catheter was usually left in situ for about 24 h and the majority of the patients were discharged the next day. All patients have been followed up at least every 6 months for a mean period of 27 months (range 16 to 41 months). The durability of surgery has been checked with linear array transrectal sonography and by urodynamic evaluation. Sixty-nine patients (92%) had adequate voiding, minimal to absent autonomic dysreflexia and no significant symptomatic urinary tract infection. There were seven patients who required repeat laser surgery within 2 to 5 months. All subsequent patients are voiding well with wide open Bladder-Neck and posterior urethra as shown on a voiding cystourethrogram.
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Contact laser transurethral surgery using a sapphire chisel probe firing Nd:YAG
Lasers in Surgery: Advanced Characterization Therapeutics and Systems V, 1995Co-Authors: I PerkashAbstract:This is a report on a modified technique for use of a contact laser for transurethral surgery to improve voiding in spinal core injury patients. To produce a channel for voiding, chisel sapphire tips are used to deliver adequate Nd:YAG laser energy to vaporize tissue blocking the urethral passage. We present data on 51 spinal cord injury patients (range 29 - 76 years) who had contact laser surgery in the past 22 months. Urodynamic studies showed detrusor sphincter dyssynergia in 82% of patients. On cystoscopic examination prior to surgery, 39% had associated enlargement of the prostate and/or Bladder-Neck Stenosis. Thirty-one percent also had associated strictures in the bulbous urethra. For transurethral resection of the sphincter, a 12 o'clock incision was made by passing the contact probe repeatedly and/or buttonholing and then cutting the overlying tissue. For vaporization of the prostate and eradication of urethral strictures, the contact chisel probe was passed repeatedly over the surface and also buttonholes were drilled. The overlying tissue was incised with the laser chisel. The buttonhole technique expedited the procedure for creation of an adequate urethral channel for voiding. During surgery, there was minimal blood loss of about 25 - 50 ml per procedure except in 2 patients who lost 100 to 150 ml. All except 4 patients voided satisfactorily within 1 to 8 days (mean 2.7 days) when the catheter was removed following surgery. The initial 4 patients who did not void well are also voiding satisfactorily following repeat surgery.
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Laser Sphincterotomy and Ablation of the Prostate Using a Sapphire Chisel Contact Tip Firing Neodymium:Yag Laser
The Journal of Urology, 1994Co-Authors: I PerkashAbstract:AbstractI report a modified technique for use of a contact laser for urological endoscopic surgery in spinal cord injury patients. Instead of the usual technique of passing the laser probe for surface vaporization, subsurface buttonholes were drilled with subsequent incision of the overlying tissue. As a result, creation of an adequate channel was expedited with excellent hemostasis. A total of 40 spinal cord injury patients (mean age 50.1 years, range 28 to 76) underwent transurethral surgery for Bladder outlet obstruction using a sapphire contact laser tip. Of the patients 50% had undergone previous transurethral surgery and were not voiding well. Urodynamic studies demonstrated detrusor-sphincter dyssynergia in 37 patients (92.5%). Avoiding cystoure- throgram was done in 83% of the patients and showed vesicoureteral reflux in 17%. On cystoscopic examination 32.5% of the patients had an associated enlarged prostate, 32% stricture of the bulbous urethra and 20% Bladder Neck Stenosis. Apart from transuret...
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Laser sphincterotomy and ablation of the prostate using a sapphire chisel contact tip firing neodymium:YAG laser.
The Journal of urology, 1994Co-Authors: I PerkashAbstract:I report a modified technique for use of a contact laser for urological endoscopic surgery in spinal cord injury patients. Instead of the usual technique of passing the laser probe for surface vaporization, subsurface buttonholes were drilled with subsequent incision of the overlying tissue. As a result, creation of an adequate channel was expedited with excellent hemostasis. A total of 40 spinal cord injury patients (mean age 50.1 years, range 28 to 76) underwent transurethral surgery for Bladder outlet obstruction using a sapphire contact laser tip. Of the patients 50% had undergone previous transurethral surgery and were not voiding well. Urodynamic studies demonstrated detrusor-sphincter dyssynergia in 37 patients (92.5%). A voiding cystourethrogram was done in 83% of the patients and showed vesicoureteral reflux in 17%. On cystoscopic examination 32.5% of the patients had an associated enlarged prostate, 32% stricture of the bulbous urethra and 20% Bladder Neck Stenosis. Apart from transurethral sphincterotomy in these patients, ablation of the prostate, stricture and eradication of Bladder Neck Stenosis, as indicated, were also done with the contact laser. Blood loss was approximately 25 to 50 ml. per procedure except for 2 initial patients with a blood loss of 100 to 150 ml. Approximately 3,500 to 8,900 joules accumulated energy were used for transurethral sphincterotomy and 11,000 to 37,000 joules for transurethral resection of the prostate. An indwelling Foley catheter was placed postoperatively for a mean of 3 days (range 1 to 8). All patients were followed for 6 to 23 months (mean 13.1). Four patients failed laser transurethral sphincterotomy: 1 due to inadequate initial incision and 3 who initially underwent laser transurethral incisions of the prostate and had persistent detrusor-sphincter dyssynergia (all had relief following laser transurethral sphincterotomy). All subsequent patients are voiding well with a wide open Bladder Neck and posterior urethra as shown on a voiding cystourethrogram.
Philip C Reiss - One of the best experts on this subject based on the ideXlab platform.
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the t plasty as therapy for recurrent Bladder Neck Stenosis success rate functional outcome and patient satisfaction
World Journal of Urology, 2017Co-Authors: Clemens M. Rosenbaum, Roland Dahlem, Margit Fisch, Valentin Maurer, Luis A. Kluth, Malte W. Vetterlein, Victor Schuettfort, Philip C ReissAbstract: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.
