UP-102 Y-V Plasty Reconstruction For The Treatment of Refractory Bladder Neck Contracture: Clinical and Patient-Reported Outcomes
Thursday June 27, 2019 from
TBD
Presenter

Samer Shamout, Canada

Clinical Fellow

Southern Alberta Institute of Urology

Rockyview General Hospital/ University of Calgary

Abstract

Y-V plasty reconstruction for the treatment of refractory bladder neck contracture: Clinical and patient-reported outcomes

Samer Shamout1,2, Henry Yao1,2, Kevin V. Carlson1,2, Richard J. Baverstock1,2.

1Department of Surgery, Division of Urology, University of Calgary, Calgary, AB, Canada; 2Vesia [Alberta Bladder Centre], University of Calgary, Calgary, AB, Canada

Introduction: Highly recurrent bladder neck contracture (BNC) following transurethral surgery of the prostate is rare but troublesome condition. With lack of standardized treatment; bladder neck reconstruction remains one of the most accepted therapeutic options for recurrent BNC. This study evaluates the success rate, functional and patient-reported outcomes (PRO) of open Y-V plasty in treatment of refractory BNC after transurethral surgery of the prostate.

Methods: We present medium-term results of 16 consecutive patients with refractory BNC who underwent open Y-V plasty at a tertiary care centre between  2017 and 2020.  All patients presented with voiding dysfunction after two or more failed attempts of endoscopic treatments. Perioperative evaluation, operative data and postoperative outcome were analyzed. Postoperative complications were recorded and classified according to the Clavien classification. Functional and patient-reported outcomes were evaluated using standard uroflowmetry and validated self-reported questionnaires. The questionnaires included validated IPSS, IPSS-QoL, OAB-V8 and IIEF-5 survey items.

Results: Sixteen patients underwent the open Y-V plasty procedure, most of whom developed BNC secondary to TURP [n=11, (73%).] Mean age at surgery age (SD) was 66.7 (5.7) years. Mean follow-up was 16.1 (6.5) months. Success rate was 100%. Post-operative Qmax improved significantly [pre-OP 6.5 (8.3) ml/s vs post-OP was 14.6 (7.5) ml/s, p = 0.001]. Mean post-void residual decreased significantly [pre-OP 204.6 (197.5) ml vs post-OP 47.8 (72.9) ml, p = 0.009)]  (Table 1). De-novo-urgency was the most common postoperative complication in 47% of subjects. Age at surgery (r = 0.52) and BMI (r = 0.52) were positively correlated with changes in OAB-V8 score p = <0.05. 

Conclusions: Y-V plasty represents a safe and viable treatment option with high success rates and favorable patient reported outcomes for refractory bladder neck contracture. Residual storage symptoms are usually attributable to underlying bladder dysfunction leading to a suboptimal treatment outcome.


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