The T-plasty: a modified YV-plasty for highly recurrent bladder neck contracture after transurethral surgery for benign hyperplasia of the prostate: clinical outcome and patient satisfaction

• Published in: World journal of urology Vol. 34; no. 10; pp. 1437 - 1442
• Main Authors: Reiss, C. P., Rosenbaum, C. M., Becker, A., Schriefer, P., Ludwig, T. A., Engel, O., Riechardt, S., Fisch, M., Dahlem, R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2016; Springer Nature B.V
• Subjects: Aged; Clinical outcomes; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Original Article; Patient Satisfaction; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - surgery; Quality of Life; Reconstructive Surgical Procedures - methods; Retrospective Studies; Time Factors; Transurethral Resection of Prostate - methods; Treatment Outcome; Urinary Bladder - surgery; Urinary Bladder Neck Obstruction - etiology; Urinary Bladder Neck Obstruction - surgery; Urologic Surgical Procedures - methods; Urology; Bladder reconstruction; Benigne prostate hyperplasia; Bladder neck contracture; Stricture recurrence
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-016-1779-5

Objective
To describe a modified surgical technique for treatment of highly recurrent bladder neck contracture (BNC) after transurethral surgery for benign hyperplasia and to evaluate success rate and patient satisfaction of this novel technique.
Methods
Ten patients with highly recurrent BNC and multiple prior attempts of endoscopic treatment underwent the T-plasty. Perioperative complications were recorded and classified according to the Clavien classification. Patient reported functional outcomes were retrospectively analysed using a standardized questionnaire assessing recurrence of stenosis, incontinence, satisfaction and changes in quality of life (QoL). The questionnaires included validated IPSS and SF-8-health survey items.
Results
Mean age at the time of surgery was 69.2 years (range 61–79), and the mean follow-up was 26 months (range 3–46). No complications grade 3 or higher according to the Clavien classification occurred. Success rate was 100 %. No de novo stress incontinence occurred. Urinary stream was described as very strong to moderate by 80 % of the patients, mean post-operative IPSS-score was 11.3 (range 4–29), and mean post-operative IPSS-QoL was 2.4 (range 1–5). Patients satisfaction was very high or high in 90 %, and QoL improved in 90 %. The SF-8-health survey showed values comparable to the reference population.
Conclusion
The T-plasty represents a safe and valuable option in treating highly recurrent BNC after surgery for benign hyperplasia. It offers multiple advantages compared to other techniques such as a single-staged approach and the opportunity for reconstruction of a reliable wide bladder neck by usage of two well-vascularized flaps. Success rate, low rate of complications and preservation of continence are highly encouraging.