Oncotarget | https://doi.org/10.18632/oncotarget.27276 Sergei M. Danilov, Alexey V. Kadrev, Olga V. Kurilova, Victoria E. Tikhomirova, Olga V. Kryukova, Vadim N. Mamedov, David M. Kamalov, Natalia V. Danilova,...

Bladder neck contracture (BNC) is one of the most common complications of surgical treatment of prostate diseases. The rate of postoperative BNC varies depending on the type of surgical treatment used. The options for treatment techniques for BNC can vary from endoscopic interventions to complex (abdominal) surgical interventions. This review evaluates various alternative surgical methods of BNC treatment. The search and analysis of publications in the databases PubMed (MEDLINE), Scopus, Cochrane Library, according to the keywords, “bladder neck sclerosis,” “benign prostatic hyperplasia,” “BNC,” “bladder neck stenosis,” “balloon dilation,” “treatment.” As a result, 71 publications were selected and included in this review. In addition to the standard treatment methods in the form of transurethral resection and incision of the bladder neck using electricity and laser energy, the urologist also has alternative methods of treatment, such as balloon dilation, placement of urethral stents, instillation of the bladder or intraoperative injection of cytostatic drugs, hormones, hyaluronic acid derivatives, and biomedical cell products into the bladder neck area. Although transurethral resection is currently the main treatment option for BNC, the recurrence rate after this procedure can reach up to 38%. According to the literature, balloon dilation can be a promising and minimally invasive method of treatment for recurrent BNC. This method can be used as the first stage in the treatment of recurrent contracture deformity. Furthermore, intravesical instillation of various anti-inflammatory drugs and cytostatics can be promising directions in the treatment and prevention of BNC.

Introduction. Bladder neck sclerosis (BNS) is a widespread complication of the surgical treatment of prostate diseases. Nevertheless, the etiology and pathogenesis of BNC development are not well understood, the frequency and degree of iatrogenic BNS varies depending on what treatment took place before its appearance. Treatment options for BNS can vary from simple dilatation to complex surgical interventions. Clinical variants of BNS, as well as their treatment options, vary in complexity, from simple short annular contractures to obliterating stenosis, which requires a significant expansion of surgical treatment volume. The purpose of this study – is to assess the effectiveness of modern and alternative methods of prevention and treatment of BNS based on the analysis of published studies. Materials and methods. The search and analysis of publications in the databases PubMed, Scopus, Cochrane Library, elibrary, according to the keywords, «bladder neck sclerosis», «benign prostatic hyperplasia», «bladder neck contracture», «bladder neck stenosis», «balloon dilatation», «treatment». As a result, 46 publications were selected and included in this review. Results and discussion. In this review, we highlighted the routine and alternative methods of BNS treatment. Currently, there are quite modern methods for treating prostate diseases (using robotic techniques, electrosurgical resections, and enucleations, laser enucleations, etc.), which are often complicated by secondary BNS. Nowadays, there are a lot of routine and alternative methods of treatment of secondary BNS in the urologist’s armamentarium. Routine methods include TUR and incision of the bladder neck using electric and laser energy, alternative methods include balloon dilatation, installation of a urethral stent, instillation (or intraoperative injection) of the bladder with cytostatics, hormonal drugs, derivatives of hyaluronic acid, and biomedical cell products. Conclusions. According to the literature from the listed alternative treatment methods for BNS, balloon dilatation is the most promising one. Based on the results of the literature analysis, we concluded that the use of balloon dilatation as a method of primary (least invasive) treatment and prevention of the occurrence of BNS is advisable.

Purpose: The aim was to assess the results of balloon dilation in patients with bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH). Materials and Methods: The study involved 120 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent transurethral resection (TUR) of the bladder neck and were divided into two groups: Group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, whereas the control group B (n = 75) included men who were treated with alpha-blockers alone. Results: In 9 months after TUR and 3 months after the 4^th balloon dilation procedure in Group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life was 4.2 ± 1.2 (P > 0.05). In Group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (P > 0.05), respectively. In addition, the mean flow rate in Group A was 13.2 ± 5.4 ml/s, whereas in Group B, it was 8.7 ± 4.9 ml/s (P < 0.05). There was a significant decrease in the postvoid residual urine volume from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in Group A, whereas, in Group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (P > 0.05). Furthermore, 28.0% of patients of Group B and 13.3% of patients of Group A underwent repeated TUR of the bladder neck in 9 months follow-up period (P < 0.05). Conclusion: Balloon dilation is a safe less invasive procedure and can reduce the possibility of BNC recurrence and thus the rate of repeated transurethral interventions.