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MINERVA UROLOGICA E NEFROLOGICA
Rivista di Nefrologia e Urologia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Urologica e Nefrologica 2017 April;69(2):133-43
Copyright © 2016 EDIZIONI MINERVA MEDICA
Bladder neck contracture after surgery for benign prostatic obstruction
Luca CINDOLO 1 ✉, Michele MARCHIONI 2, Esteban EMILIANI 3, Piergustavo DE FRANCESCO 2, Giulia PRIMICERI 2, Pietro CASTELLAN 1, Luigi SCHIPS 1
1 Robotic Unit, Department of Urology, ASL Abruzzo 2, SS. Annunziata Hospital, Chieti, Italy; 2 Department of Urology, SS. Annunziata Hospital, G. D’Annunzio University, Chieti, Italy; 3 Department of Urology, Tenon Hospital, Université Pierre et Marie Curie Paris IV, Paris, France
INTRODUCTION: Over the last few decades, numerous surgical procedures have been proposed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, all are characterized by a certain rate of treatment failure due to bladder neck contracture (BNC). Treatment of secondary BNC appears to be challenging. The main purpose of this review is to evaluate current published knowledge on this topic.
EVIDENCE ACQUISITION: The MEDLINE/PubMed database was searched for all original articles published between 2000 and 2016 analyzing the incidence, prevalence and management of BNC as a post-operative complication following surgical treatment of LUTS/BPH. Prospectively designed studies, and those with prospectively maintained databases and/or rigorous inclusion and exclusion criteria were included. Given the lack of prospective studies examining treatment options for BNC, retrospective studies were also included in this section.
EVIDENCE SYNTHESIS: Thirty-four studies were included. The huge heterogeneity of patients, gland characteristics, surgical strategies and follow-up procedures limited the overall quality of results. BNC incidence after surgery for LUTS/BPH ranges from 0% to 9.6%. Given the dearth of well-designed studies, it seems rational to leave the choice of treatment procedure to the specialist’s own decision.
CONCLUSIONS: BNC incidence varies greatly depending on the examined cohorts, with only few precautionary measures available for prevention. Treatment is challenging and it seems reasonable to leave the choice of BNC treatment technique to the surgeon’s own judgement.
KEY WORDS: Urinary bladder neck obstruction - Prostatic hyperplasia - Complications - Solid-state lasers - Prostatectomy