Comprehensive study of bladder neck contracture after transurethral resection of prostate

Objectives. To test the validity of transurethral resection of the prostate (TURP) plus transurethral incision (TUI) of bladder neck as an alternative to TUI of the prostate, a nonrandomized and retrospective study was done to review comprehensively the incidence of, severity of, and risk factors for bladder neck contracture (BNC) in patients with benign prostatic hyperplasia who underwent transurethral surgery. Methods. The evaluation parameters included age, prostate-specific antigen level, urinalysis and uroflowmetry findings, voided volume, presence of vesical stones and urinary retention, surgical type, adenoma weight, and perioperative morbidities. Results. Of the 1470 patients studied, 1135 (77.2%) were eligible for analysis. At a mean follow-up of 37.9 months, 110 patients (9.7%) had developed BNC. The adenoma weight, blood transfusion, and postoperative maximal and mean flow rate in patients with BNC were significantly less than in patients without BNC. The incidence of BNC in the TURP group was greater than that in the TURP plus TUI group (12.3% versus 6%, P = 0.000). BNC was completely prevented using TURP plus TUI if the adenoma weight was greater than 30 g. However, in the TURP group, 4% of patients developed BNC even with an adenoma weight greater than 50 g. Multivariate analyses showed that adenoma weight and surgical type were significant risk factors for BNC. Patients with associated vesical stones were less prone to develop BNC. Conclusions. TURP plus TUI provides a pathologic diagnosis, and with minimal morbidity, it can be an alternative to TUI of the prostate in selected patients. Personal diathesis may play a role in the pathogenesis of BNC.