Modified Y/V-plasty for the treatment of recurrent bladder neck contracture: Outcome and patient satisfaction.

Introduction & Objectives


Recurrent bladder neck contractures after surgery for benign prostatic hyperplasia are a rare but a troublesome complication. In these cases, open surgery can be the last therapeutic option before urinary diversion. The study was conducted to assess the outcome, satisfaction and the improvement on quality of life (QoL) for Y/V-plasty in a modified technique in patients with highly recurrent bladder neck contracture (BNC).


Material & Methods


Comprehensive retrospective analysis by pts chart review and standardized questionnaire including validated questionnaires (IPSS, SF-8, ICIQ-SF) of 10 pts treated by modified Y/V-plasty for highly recurrent BNC after surgery for benign prostatic hyperplasia in 2009-2012.
Previous surgeries, recurrence rate, complications, micturition status, incontinence, satisfaction and quality of life were assessed.
Difference to the standard Y/V-plasty was a T-shaped incision of the anterior bladder wall. By this technique two well vascularized flaps were created, which offer the possibility to reconstruct a wide bladder neck and anterior prostatic urethra.


Results


Mean age was 69.2 yrs. (range 61-79), mean follow up was 26 months (3-46). All pts. had had multiple previous (trans-)urethral surgeries (mean 3.5, range 2-5).
Etiology was transurethral resection of the prostate in 70%, holmium enucleation of the prostate in 20% and HiFU of the prostate in 10%.
Success rate was 100%. No complications were reported. No de novo stress incontinence occurred. 1 pt. noted a pre- and postoperative urge incontinence due to overactive bladder.
50% of pts. reported a strong or very strong, 20% a moderate and 20% a weak urinary stream. Mean postoperative IPSS-score was 11.3 (range 4-29), postoperative IPSS-QoL was delighted or pleased in 70%, mixed in 10% and due to urodynamic hypocontractile detrusor in one pt. mostly dissatisfied.
Pts. satisfaction was very high in 70%, high in 20%, 10% were undecided. Quality of life improved in 90%, 10% report no change.


Conclusions


The technique of modified Y/V-plasty for the repair of highly recurrent bladder neck contractures seems to represents a successful and safe method and improves quality of life with good satisfaction rates. No complications were seen.