This study evaluates the effectiveness of bladder neck incision (BNI) with transurethral steroid injection as a treatment for recurrent bladder neck contracture (BNC), a common complication following radical retropubic prostatectomy (RRP). BNC can typically be managed with a single endoscopic intervention, but some cases recur, causing significant morbidity and requiring further treatment. This study reviewed cases at two regional centers in New Zealand, where patients who experienced BNC recurrence after an initial BNI or dilation (without steroid injection) were treated with BNI and intralesional steroid injections. The steroid aims to reduce inflammation and prevent further scar formation, which can minimize the likelihood of recurrence.
Data was collected from November 2011 to March 2023. Follow-up evaluations were conducted three months post-procedure, using the International Prostate Symptom Score and measuring urinary flow rates. Patients were considered recurrence-free upon discharge from urology care or following a continence procedure, indicating stability of the contracture. In the cohort of 33 patients, 72% were recurrence-free after one procedure. For patients requiring a second treatment, the recurrence-free rate rose to 84%. Notably, all five patients who developed recurrent BNC post-salvage radiotherapy achieved symptom relief with a single BNI and steroid injection. Over an average follow-up of 34 months, no adverse effects were reported, underscoring the safety of the approach.
The findings suggest that BNI with transurethral steroid injection is a simple, low-cost, and effective treatment for managing recurrent BNC after RRP, including in patients with a history of salvage radiotherapy. This technique offers a promising approach to reducing contracture-related morbidity and improving quality of life for patients with persistent BNC.
