1Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, Department of Urology, Denver Health Medical Center, ...
TRANSVESICAL VENTRAL BUCCAL MUCOSA GRAFT INLAY CYSTOPLASTY FOR RECONSTRUCTION OF REFRACTORY BLADDER NECK CONTRACTURES AFTER BENIGN PROSTATIC HYPERPLASIA SURGERY: SURGICAL TECHNIQUE AND PRELIMINARY RESULTS Rodrigo Donalisio da Silva, MD1, Jeffrey M. Marks, MD1, Lisa Parrillo, MD1, Fernando J. Kim, MD¹, Brian Flynn, MD1 1Department
of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, Department of Urology, Denver Health Medical Center, Denver, CO.
INTRODUCTION
RESULTS
• The incidence of bladder neck contracture (BNC) after surgical treatment of benign prostatic hyperplasia (BPH) varies in literature up to 20%.
Previous Interventions
Surgical Technique
Patient Characteristics Preoperative Data
Previous Surgeries
Buccal Mucosa Graft Inlay Cystoplasty (n=11)
• BNC is usually identified in the first two years after initial endoscopic management and treatment.
Age, years
Simple RP 9%
66.2 (52-80.5)
• Success rate for endoscopic treatment is ~90% but the rate declines after repeated treatment.
# Previous Treatments per Person
2.3
Urinary Retention (n, %)
9 (82)
• Treatment of highly recurrent BNC is challenging and generally requires reconstructive surgery in patients that do not want urinary diversion.
Foley Catheter (n, %)
8 (73)
Cystoscopy (n, %)
PVP 27% TURP 64%
11 (100)
RUG (n, %)
1 (9.1)
Stricture Diameter, Fr
9.1 (4-14)
OBJECTIVES
Figure 1: Transvesical ventral wedge resection of BNC
Perioperative Data
• The aim of this study is to describe and report outcomes of bladder neck reconstructive surgery using buccal mucosa graft for highly recurrent BNC.
Buccal Mucosa Graft Inlay Cystoplasty (n=11) Graft Size, cm²
METHODS
• All procedures were performed in a tertiary academic center by a dedicated team of urology reconstructive surgeons under guidance of one senior reconstructive urologist. • Success was considered patient being able to void without catheterization 90% of the time.
298 (237-400)
Hospital Stay, d
3.3 (1-8) Follow-up, months Success (n, %) IPSS QoL Occasional Urinary Retention (n, %) Ileus (n, %) Incontinence (n, %) Fistula (n, %) Epididymorchitis (n, %) Additional Procedures (n, %)
Previous Treatments 4
4
Number o f patients
• Inclusion criteria enrolled patients with BNC after BPH surgery that failed endoscopic treatment.
Outcomes and Complications
11.3 (8-18)
Operative Time, m
• We performed a retrospective analysis of patients submitted to transvesical ventral buccal mucosa graft inlay cystoplasty for highly recurrent BNC after surgical treatment of BPH.
Outcomes
2 1
DVIU
TUIBN
TUMT
TURBNC
Figure 2: Spread fixation of BMG
CONCLUSIONS • Highly recurrent BNC reconstruction after surgical treatment of BPH is challenging. • Inlay technique using buccal mucosa graft provides good outcomes with low morbidity for patients that failed multiple endoscopic treatments for BNC after treatment of BPH.
Buccal Mucosa Graft Inlay Cystoplasty (n=11) 19.3 (0-62) 10 (91) 14 (7-26) 3.1 (0-6) 4 (36) 0 1 (9.1) 0 2 (18) 2 (18)
